Classification of acute diverticulitis in the left colon with ultrasonography and computed tomography: Value of current severity classification schemes.

BACKGROUND AND AIMS: The current management of acute diverticulitis of the left colon (ADLC) requires tests with high prognostic value. This paper analyzes the usefulness of ultrasonography (US) in the initial diagnosis of ADLC and the validity of current classifications schemes for ADLC. PATIENTS: This retrospective observational study included patients with ADLC scheduled to undergo US or computed tomography (CT) following a clinical algorithm. According to the imaging findings, ADLC was classified as mild, locally complicated, or complicated. We analyzed the efficacy of US in the initial diagnosis and the reasons why CT was used as the first-line technique. We compared the findings with published classifications schemes for ADLC. RESULTS: A total of 311 patients were diagnosed with acute diverticulitis; 183 had ADLC, classified at imaging as mild in 104, locally complicated in 60, and complicated in 19. The diagnosis was reached by US alone in 98 patients, by CT alone in 77, and by combined US and CT in 8. The main reasons for using CT as the first-line technique were the radiologist's lack of experience in abdominal US and the unavailability of a radiologists on call. Six patients diagnosed by US were reexamined by CT, but the classification changed in only three. None of the published classification schemes included all the imaging findings. CONCLUSIONS: US should be the first-line imaging technique in patients with suspected ADLC. Various laboratory and imaging findings are useful in establishing the prognosis of ADLC. New schemes to classify the severity of ADLC are necessary to ensure optimal clinical decision making.

Categorización de la diverticulitis aguda de colon izquierdo mediante ecografía y tomografía computarizada. Valor de las clasificaciones de gravedad disponibles / Classification of acute diverticulitis in the left colon with ultrasonography and computed tomography: value of current severity classification schemes

Antecedentes y objetivoEl manejo actual de la diverticulitis aguda de colon izquierdo requiere pruebas con alto valor pronóstico. Los objetivos del estudio son analizar la utilidad de la ecografía como método diagnóstico inicial y evaluar la validez de las clasificaciones actuales de gravedad de dicha enfermedad.PacientesEstudio observacional retrospectivo de pacientes con diverticulitis aguda de colon izquierdo. Se solicitó ecografía o tomografía computarizada (TC) siguiendo un algoritmo clínico. Tras los hallazgos de imagen, se clasificó la enfermedad como leve, localmente complicada y complicada. Se evaluaron la eficacia de la ecografía como herramienta diagnóstica inicial y las razones por las que se realizó una TC como técnica inicial. Se compararon los hallazgos con las clasificaciones de diverticulitis publicadas.ResultadosDe 311 pacientes con diverticulitis aguda, se seleccionaron 183 con diverticulitis aguda de colon izquierdo, que fueron clasificadas por imagen como leves (104), localmente complicadas (60) y complicadas (19). En 98 pacientes, el diagnóstico se realizó por ecografía, en 77 por TC y en 8 mediante ambas. Las principales razones de utilización inicial de TC fueron falta de experiencia del radiólogo en ecografía abdominal y falta de disponibilidad de un radiólogo de guardia. A 6 pacientes diagnosticados por ecografía se les realizó una nueva evaluación por TC, pero solo en 3 cambió la clasificación. Ninguna de las clasificaciones publicadas recoge todos los hallazgos en imagen.ConclusionesLa ecografía debería ser la primera técnica a utilizar para el diagnóstico de diverticulitis aguda de colon izquierdo. Para establecer el pronóstico de la enfermedad, son útiles diversos parámetros analíticos y hallazgos de imagen. Para una apropiada toma de decisión terapéutica se necesitarían nuevas clasificaciones de gravedad. (AU)

Background and aimsThe current management of acute diverticulitis of the left colon (ADLC) requires tests with high prognostic value. This paper analyzes the usefulness of ultrasonography (US) in the initial diagnosis of ADLC and the validity of current classifications schemes for ADLC.PatientsThis retrospective observational study included patients with ADLC scheduled to undergo US or computed tomography (CT) following a clinical algorithm. According to the imaging findings, ADLC was classified as mild, locally complicated, or complicated. We analyzed the efficacy of US in the initial diagnosis and the reasons why CT was used as the first-line technique. We compared the findings with published classifications schemes for ADLC.ResultsA total of 311 patients were diagnosed with acute diverticulitis; 183 had ADLC, classified at imaging as mild in 104, locally complicated in 60, and complicated in 19. The diagnosis was reached by US alone in 98 patients, by CT alone in 77, and by combined US and CT in 8. The main reasons for using CT as the first-line technique were the radiologist's lack of experience in abdominal US and the unavailability of a radiologists on call. Six patients diagnosed by US were reexamined by CT, but the classification changed in only three. None of the published classification schemes included all the imaging findings.ConclusionsUS should be the first-line imaging technique in patients with suspected ADLC. Various laboratory and imaging findings are useful in establishing the prognosis of ADLC. New schemes to classify the severity of ADLC are necessary to ensure optimal clinical decision making. (AU)

Past and current trends in soy supplementation: a bibliographic study.

The aim was to determine in what areas the therapeutic application of soy predominates in clinical trials and to assess the emerging fields of its use by means of an analysis of bibliographic resources. A search was performed in the MEDLINE database up to 31 december 2004, limited to the Title/Abstract field, and Clinical Trials as the type of publication. The abstracts from the publications selected (n=86) were reviewed and different variables were assessed. A total of 3280 subjects were included: 15% men and 59% women (71% postmenopausal). The studies were performed basically in healthy individuals (71%). Twenty five percent of the studies investigated plasma levels of different metabolites and 21% determined hormone or lipid profiles. After the year 2000 a new population focus was detected, with the publication of two studies in elite gymnasts and judoists, with positive results. The present observations indicate that soy supplementation in the competitive sports elite may be an emerging application.

[Preoperative chemotherapy and total parenteral nutrition in colon cancer]. / Quimioterapia pre-operatoria y nutrición parenteral total en la neoplasia de colon.

AIM: The objective of this study was to determine the effect of TPN after surgery in patients with colon carcinoma and preoperative chemotherapy. MATERIAL AND METHOD: The study included 27 patients, 16 men and 11 women, with a mean age of 62.1 +/- 11.2 years. The patients were divided into two groups according to whether they had undergone chemotherapy (Group A; n = 11) or not (Group B, control; n = 16) prior to surgery. Almost two thirds of the patients were in stage III of the disease. Among those receiving this treatment, 60% were given 5-fluorouracil plus leucovorin at a dose of 5.5 +/- 2.7 cycles/patient and the others received different regimens. TPN was established early with a mean of 11.7 +/- 9.2 days. The clinical and nutritional assessment was performed before surgery and at the end of TPN administration. RESULTS: The mean body mass index (BMI) was 24.1 +/- 2.2 kg/m2. Comparison between the groups before the start of TPN showed statistically significant differences in red blood cell and platelet counts (P = .013 and P = .02, respectively). These differences had disappeared at completion of TPN, suggesting that this treatment can reverse the hematological changes induced by chemotherapy. CONCLUSION: In patients who receive chemotherapy before surgery and in whom TPN it was indicated the combination of these two treatments could be beneficial.

Quimioterapia pre-operatoria y nutrición parenteral total en la neoplasia de colon / Preoperative chemotherapy and total parenteral nutrition in colon cancer

Objetivo: Valorar el efecto de la NPT después de la cirugía en pacientes con neoplasia de colon y quimioterapia previa a la resección neoplásica. Material y método: Se incluyeron 27 pacientes (16 hombres y 11 mujeres) de 62,1 ± 11,2 años de edad. Los pacientes fueron divididos en 2 grupos considerando si recibían (Grupo A; n = 11) o no (Grupo B, control; n = 16) quimioterapia previa a la cirugía. Un 59% de los pacientes se encontraba en estadio III de la enfermedad recibiendo, el 60% de ellos, tratamiento con 5-fluorouracilo más leucovorin a razón de 5,5 ± 2,7 ciclos/paciente y el resto otras pautas diferentes. La NPT se instauró de forma precoz tuvo una duración media de 11,7 ± 9,2 días. La valoración clínica y nutricional se realizó antes de la cirugía y al final de la NPT. Resultados: El índice de masa corporal (ICM) medio fue de 24,1 ± 2,2 kg/m2. Al comparar ambos grupos antes del inicio de la NPT se hallaron diferencias estadísticamente significativas en el recuento de hematies y en el de plaquetas (p = 0,013 y p = 0,02, respectivamente). Estas diferencias desaparecieron al finalizar el tratamiento. Conclusion: La administración de NPT puede normalizarlos cambios hematológicos debidos a la quimioterapia, por lo que en los casos en que se administre antes de la intervención quirúrgica resulta una buena opción terapéutica (AU)

Aim: The objetive of this study was to determine the effect of TPN after surgery in patients with colon carcinoma and preoperative chemotherapy. Material and method: The study included 27 patients, 16 men and 11 women, with a mean age of 62.1 ± 11.2 years. The patients were divided into two groups according to whether they had undergone chemotherapy (Group A; n = 11) or not (Group B, control; n = 16) prior to surgery. Almost two thirds of the patients were in stage III of the disease. Among those receiving this treatment,60% were given 5-fluorouracil plus leucovorin at a dose of 5.5 ± 2.7 cycles/patient and the others received different regimens. TPN was established early with a mean of 11.7 ± 9.2 days. The clinical and nutritional assessment was performed before surgery and at the end of TPN administration. Results: The mean body mass index (BMI) was 24.1 ± 2.2 kg/m2. Comparison between the groups before the start of TPN showed statistically significant differences in red blood cell and platelet counts (P = .013 and P = .02, respectively). These differences had disappeared at completion of TPN, suggesting that this treatment can reverse the hematological changes induced by chemotherapy. Conclusion: In patients who receive chemotherapy before surgery and in whom TPN it was indicated the combination of these two treatments could be beneficia (AU)

Aporte dietético de suplementos en pacientes ancianos hospitalizados / No disponible

Fundamentos La prevalencia de la malnutrición hospitalaria y la edad hace que los pacientes ancianos sometidos a cirugía mayor sea un colectivo de alto riesgo con una evolución clínica adversa asociada a una mayor mortalidad. El objetivo del estudio es valorar el aporte nutricional dela dieta hospitalaria más suplementos, en pacientes ancianos con riesgo de desnutrición, durante siete días de ingreso en el hospital. Material y métodosSe estudiaron dos grupos: A, pacientes hospitalizados desnutridos o en riesgo de desnutrición (n=74) con una edad media de74,8±12,2 años (varones 53%) y B, un grupo control (n=70) con una edad media de60,8±10,8 años (50% varones). Los macronutrientes se prescribieron y contabilizaron del nomenclátor del Código de dietas del hospital. La ingesta real se estimó cualitativamente después de la entrevista con el paciente y los resultados cuantitativos se estimaron mediante el software DietSource 1.2. Al cálculo obtenido se le añadió el aporte proveniente del suplemento nutricional administrado (1-3 veces/día). Las dietas administradas fueron: basal(n=20), blanda III (n=19), líquida (n=14),blanda II (n=6), diabética (n=6), hiperproteica(n=5) y dietas de progresión (n=4). Resultados El suplemento más utilizado fue ClinutrenDessert® (n=48). Basalmente la comparación del aporte nutricional entre los grupos A y B, mostró niveles inferiores en los pacientes ingresados, con diferencias significativas en todas las variables excepto los carbohidratos. El incremento del aporte energético después de dar suplementos presentó una gran variabilidad individual (6.9-84.1%) pero incrementó el aporte de todos los nutrientes (coeficientes de correlación: r=0.926 a r=0.984; p<0.05).Conclusiones En pacientes ancianos hospitalizados, el aporte de nutrientes provenientes de la dieta es inferior al definido en las RDA internacionales pero con la administración de suplementos se consigue mejorar el aporte nutricional y aproximarse a los requerimientos teóricos (AU)

Background and aim The prevalence of hospital malnutrition together with advanced age makes elderly patients undergoing major surgery a high-risk population with an adverse clinical evolution and greater associated mortality. The aim of this study was to assess the nutritional supply provided by a hospital dietplus supplements in elderly patients at risk of malnutrition during seven days of hospitalization. Material and methods Two groups were studied: A) hospitalized patients who were undernourished or at risk of malnutrition (n=74) with a mean age of74.8±12.2 years (53% men) and B) a control group (n=70) with a mean age of 60.8±10.8 years(50% men). Macronutrients were prescribed and quantified according to the nomenclature of the hospital diet code. Ingestion was estimated qualitatively following an interview with the patient, and quantitative results were estimated using the DietSource software (1.2). The nutrients provided by the nutritional supplement administered (1-3 times per day) were added to this calculation. The following diets were administered: baseline (n=20), bland III (n=19), liquid(n=14), bland II (n=6), diabetic (n=6), hyperproteic(n=5) and progression diets (n=4).Results The supplement most frequently used was ClinutrenDessert® (n=48). In the baseline comparison of the nutritional contribution between groups A and B, lower levels were observed in the hospitalizedpatients, with significant differences in all the variables except carbohydrates. The increase in energy supply following supplementation showed wide individual variability (6.9%-84.1%), but it increased the supply of all the nutrients (correlation coefficients: r=0.926 to r=0.984; P<0.05).Conclusions In elderly hospitalized patients the nutritional supply provided by the diet is inferior to that defined in the international RDA. Nevertheless, with administration of dietary supplements, nutrition improves and approaches the theoretical requirements (AU)

Dipeptidyl-peptidase IV in patients with short bowel syndrome.

BACKGROUND & AIMS: The aim of this study was to determine serum dipeptidyl peptidase IV (DPP IV) levels in a population of short bowel syndrome (SBS) patients, who had achieved intestinal adaptation. METHODS: DDP IV reference values were determined in a healthy population (n=47). The SBS study group consisted of 30 patients (17 men, 13 women; 53.2+/-13.2 years). The criteria for inclusion were a remnant small bowel <200cm with or without colon resection. The time interval between resection and DPP IV measurement was >24 months except in 4 patients, in which it was 13-24 months (total mean: 64.7+/-47.3 months). Nutritional support was exclusively oral in 17 patients, oral plus cyclic TPN in 12 and TPN alone in one patient. RESULTS: The reference range for DPP IV was 10-23U/l (mean: 16.01+/-3.2). In the group of SBS patients, mean serum DPP IV was 14.02+/-3.6U/l and mean body mass index 22.07+/-4.1kg/m(2). Eleven patients (36.6%) had hyperphagia and mean DPP IV in this group was 15.2+/-4.9U/l. CONCLUSIONS: Measurement of DPP IV levels in this limited series of SBS patients who had reached intestinal adaptation showed normal levels and did not provide additional clinical information. Further analysis in the earlier postoperative period will determine whether this enzyme has a role as an indicator of evolution in these patients.

Apuntes sobre la alimentación en la época de Cervantes / Notes on diet during the time of Cervantes

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[Ingestion of antioxidants and polyamines in patients with severe burns]. / Ingesta de antioxidantes y poliaminas en pacientes con quemaduras graves.

Starting the first 24 hours after burn injury, energy supply, antioxidants and polyamines were assessed in 25 severe burn patients (20 men and 5 women) with a mean age of 45.6 +/- 20.4 years. Nutritional assessment was performed at 7, 15 and 21 days and was compared with a control group (n = 30). In 21 patients the burned body surface area was 20%-50% and in four patients it was greater than 50%. A mean decrease in energy supply of approximately 40% versus the calculated theoretical value was found in the three periods: 1,186 +/- 32; 1,117 +/- 589 and 1,331 +/- 578 kcal. In the first 15 days antioxidant ingestion was slightly lower than the recommended daily allowance for vitamin C: 60 mg versus 57 +/- 32, 57 +/- 53 and 75 +/- 53 mg, and was lower during the entire period for vitamin E: 10 mg versus 5.0 +/- 2.9; 4.5 +/- 3.0 and 5.3 +/- 3.4 mg; selenium: 40 microg versus 22.8 +/- 13.7; 22.5 +/- 9.8 and 25.7 +/- 11.2 microg and zinc: 12 mg versus 7.3 +/- 3.0, 6.8 +/- 4.8 and 8.4 +/- 5.3 mg. Taurine ingestion decreased on day 15 and significantly increased on day 21: 65.7 +/- 30 mg, 50.9 +/- 25 and 72.0 +/- 29 mg (p < 0.05). Ingestion of total polyamines did not differ significantly from the values observed in the control group and were as follows: day 7, total 45.2 +/- 23.0 umol, putrescine 16.7 +/- 10.2, spermidine 13.5 +/- 7.6 and spermine 13.6 +/- 8.8; day 15: total 41.1 +/- 38.5 and 14.9 +/- 4.0, 11.7 +/- 9.4 and 10.89 +/- 9.0; day 21: total 39.1 +/- 35.3 and 15.4 +/- 16.9, 12.3 +/- 11.4 and 17.3 +/- 16.8 umol, respectively.

Ingesta de antioxidantes y poliaminas en pacientes con quemaduras graves / Ingestion of antioxidants and polyamines in patients with severe burns

El objetivo del estudio fue valorar el aporte energético, de antioxidantes y de poliaminas de la ingesta, iniciándose desde las primeras 24 horas inmediatas a la quemadura. La valoración nutricional se realizó a los 7, 15 y 21 días y se comparó con el grupo control (n = 30). La edad de los pacientes (n = 25; 20 hombres y 5 mujeres) fue de 45,6 ± 20,4 años. Veintiún pacientes presentaron una superficie corporal quemada (SQC) entre el 20-50% y en 4 casos fue superior al 50%. Se observó un descenso del aporte energético medio de ~40% vs el teórico calculado en los 3 períodos: 1.186 ± 32, 1.117 ± 589 y 1.331 ± 578 kcal. En los primeros 15 días la ingesta de antioxidantes fue ligeramente inferior a las RDA para la vitamina C: 60 mg vs 57 ± 32, 57 ± 53 y 75 ± 53 mg, e inferior durante todo el período para la vitamina E: 10 mg vs 5,0 ± 2,9; 4,5 ± 3,0 y 5,3 ± 3,4 mg, selenio: 40 µg vs 22,8 ± 13,7, 22,5 ± 9,8 y 25,7 ± 11,2 µg y zinc: 12 mg vs 7.3 ± 3.0; 6,8 ± 4,8 y 8.4 ± 5,3 mg. La ingesta de taurina descendió en el día 15 y se incrementó significativamente en el día 21: 65,7 ± 30 mg, 50,9 ± 25 y 72,0 ± 29 mg (p < 0,05). La ingesta de poliaminas totales no difirió significativamente de los valores hallados en el grupo control y fue el día 7, 45,2 ± 23,0 µmol, putrescina 16,7 ± 10,2, espermidina 13,5 ± 7,6 y espermina 13,6 ± 8,8; día 15: total 41,1 ± 38,5 y 14,9 ± 14,0, 11,7 ± 9,4 y 10,8 ± 9,0; el día 21: total 39,1 ± 35,3 y 15,4 ± 16,9, 12,3 ± 11,4 y 17,3 ± 16,8 µmol respectivamente (AU)

Starting the first 24 hours after burn injury, energy supply, antioxidants and polyamines were assessed in 25 severe burn patients (20 men and 5 women) with a mean age of 45.6 ± 20.4 years. Nutritional assessment was performed at 7, 15 and 21 days and was compared with a control group (n = 30). In 21 patients the burned body surface area was 20%-50% and in four patients it was greater than 50%. A mean decrease in energy supply of ~40% versus the calculated theoretical value was found in the three periods: 1,186 ± 32; 1,117 ± 589 and 1,331 ± 578 kcal. In the first 15 days antioxidant ingestion was slightly lower than the recommended daily allowance for vitamin C: 60 mg versus 57 ± 32, 57 ± 53 and 75 ± 53 mg, and was lower during the entire period for vita-min E: 10 mg versus 5.0 ± 2.9; 4.5 ± 3.0 and 5.3 ± 3.4 mg; selenium: 40 µg versus 22.8 ± 13.7; 22.5 ± 9.8 and 25.7 ± 11.2 µg and zinc: 12 mg versus 7.3 ± 3.0, 6.8 ± 4.8 and 8.4 ± 5.3 mg. Taurine ingestion decreased on day 15 and significantly increased on day 21: 65.7 ± 30 mg, 50.9 ± 25 and 72.0 ± 29 mg (p < 0.05). Ingestion of total polyamines did not differ significantly from the values observed in the control group and were as follows: day 7, total 45.2 ± 23.0 umol, putrescine 16.7 ± 10.2, spermidine 13.5 ± 7.6 and spermine 13.6 ± 8.8; day 15: total 41.1 ± 38.5 and 14.9 ± 4.0, 11.7 ± 9.4 and 10.89 ± 9.0; day 21: total 39.1 ± 35.3 and 15.4 ± 16.9, 12.3 ± 11.4 and 17.3 ± 16.8 umol, respectively (AU)

Validation of an in vitro nutrition model using an enteral formula in aged neutrophils.

The aim of the study is to validate a cell culture model appropriate for assessing the effects of standard nutritional formulas on neutrophil functionality in vitro. The model consists of aged cells exposed to a commercial nutritional formula containing solely LCT as lipid component. Preliminary experiments determined dosage of formula and culture interval. Neutrophils were isolated from a pool of whole blood in healthy volunteers (18-55 years old) and cultured with and without addition of a commercial enteral diet with 3.5% lipids (equivalent to 0.04, 0.08, 0.2 and 0.4 mM of intraassay LCT) for 18, 42 or 76 hours. Based on cell viability results, doses of 0.2 and 0.4 mM LCT and culture time of 18 hours were established for subsequent experiments. Neutrophil functionality was evaluated by phagocytosis (NBT test), MDA production (lipoperoxidation index) and DNA fragmentation. Optic microscopy showed higher percentages of pre-apoptotic cells and a significant increase in DNA fragmentation as compared to controls only with an LCT concentration of 0.4 mM (p < 0.05). Interestingly, cell cultures with both 0.2 and 0.4 mM of added LCT showed significant decreases in malonyldialdehyde (MDA) release as a lipoperoxidation marker. This nutrition model of neutrophils and in vitro complete enteral commercial diet is relatively simply to execute and can be applied to different pathological conditions in which the aim is to study changes in neutrophil functionality.

Validation of an in vitro nutrition model using an enteral formula in aged neutrophils / Validación del modelo in vitro de la nutrición usando una fórmula de enteral en neutrófilos envejecidos

The aim of the study is to validate a cell culture model appropriate for assessing the effects of standard nutritional formulas on neutrophil functionality in vitro. The model consists of aged cells exposed to a commercial nutritional formula containing solely LCT as lipid component. Preliminary experiments determined dosage of formula and culture interval. Neutrophils were isolated from a pool of whole blood in healthy volunteers (18-55 years old) and cultured with and without addition of a commercial enteral diet with 3.5% lipids (equivalent to 0.04, 0.08, 0.2 and 0.4 mM of intraassay LCT) for 18, 42 or 76 hours. Based on cell viability results, doses of 0.2 and 0.4 mM LCT and culture time of 18 hours were established for subsequent experiments. Neutrophil functionality was evaluated by phagocytosis (NBT test), MDA production (lipoperoxidation index) and DNA fragmentation. Optic microscopy showed higher percentages of pre-apoptotic cells and a significant increase in DNA fragmentation as compared to controls only with an LCT concentration of 0.4 mM (p < 0.05). Interestingly, cell cultures with both 0.2 and 0.4 mM of added LCT showed significant decreases in malonyldialdehyde (MDA) release as a lipoperoxidation marker. This nutrition model of neutrophils and in vitro complete enteral commercial diet is relatively simply to execute and can be applied to different pathological conditions in which the aim is to study changes in neutrophil functionality (AU)

El objetivo del estudio ha sido validar un modelo en cultivo celular, apropiado para valorar los efectos in vitro de las fórmulas estándar y completas de nutrición enteral en la funcionalidad de los neutrófilos. El modelo consiste en células envejecidas a las que se añade una fórmula comercial de nutrición enteral que contiene LCT como fuente de lípidos. En experimentos preliminares se determinó la dosis de la fórmula y el intervalo de tiempo del cultivo. Los neutrófilos se aislaron a partir de un pool de sangre procedente de sujetos voluntarios sanos (18 a 55 años) y fueron cultivados sin y con la adición de la fórmula comercial enteral que contiene un 3,5 por ciento de lípidos con una concentración intraensayo equivalente a 0,04, 0,08, 0,2 y 0,4 mM de LCT durante 18, 42 o 76 horas. En base a los resultados de viabilidad celular obtenidos se establecieron como adecuados unas concentraciones de 0,2, 0,4 mM y un tiempo de cultivo de 18 horas en posteriores experimentos. La funcionalidad de los neutrófilos se evaluó mediante la fagocitosis (test del NBT), producción de malonildialdehído (MDA) como índice de lipoperoxidación y la fragmentación del ADN.Por microscopia óptica se observó que la adición de una dosis 0,4 mM de LCT (p < 0,05) producía porcentajes elevados de células preapoptóticas y un incremento significativo en la fragmentación del ADN al comparar con los controles sin adición. En cambio, cultivos con adición de 0,2 y 0,4 mM de LCT mostraron un descenso significativo en la producción de malonildialdehído. Este modelo de nutrición in vitro en neutrófilos y con una dieta comercial enteral completa es de relativamente fácil ejecución y puede aplicarse a diferentes condiciones patológicas en las que se estudien los cambios en la funcionalidad de los neutrófilos (AU)

Plasma urea-cycle-related amino acids, ammonium levels, and urinary orotic acid excretion in short-bowel patients managed with an oral diet.

BACKGROUND AND AIMS: The small intestine contains several enzymes involved in arginine synthesis and converts glutamine to citrulline, the major compound for endogenous arginine synthesis. This study was conducted to assess the plasma status of urea-cycle intermediates and orotic urinary excretion in short-bowel patients. METHODS: Thirteen stable short-bowel syndrome patients (7 men; 60.2+/-15.2 years) were studied. Patients were divided into moderately resected (Group A; n=6) and severely resected (Group B; n=7) according to their remnant bowel length (Group A: 61-150 cm; Group B: < or =60 cm). All subjects were consuming an oral diet plus dietetic supplements. Plasma urea-cycle amino acids, ammonium and urinary orotic acid were determined. RESULTS: Plasma glutamine levels were significantly higher in both patient groups than in the control group (P<0.001). Regarding citrulline, Group B levels were significantly lower vs. controls (P<0.001). Comparisons between patient groups showed higher arginine in Group A (P<0.05) and non-statistically lower citrulline in Group B. Blood ammonium and orotic urinary excretion were normal. CONCLUSIONS: Although plasma citrulline and glutamine alterations were found, patients showed no hyperammonemia or orotic aciduria, which suggests a certain degree of adaptation in arginine and related amino acid metabolism, when an adequate dietary supply of arginine is provided.

Effects of taurine on polymorphonuclear phagocytosis activity in burned patients.

This study determines the effects of taurine (Tau) on phagocytosis of polymorphonuclear neutrophils (PMN) isolated from normal subjects (n = 41) and severely burned patients (n = 20). Phagocytosis was measured by nitroblue of tetrazolium (NBT) reduction in samples with and without latex bead stimulation. Taurine was added at doses of 0.2, 0.4, 0.8 and 1.6 mM to stimulated samples. In control cells there were statistically significant increases in phagocytosis after addition of Tau 0.8 mM and 1.6 mM to as compared to samples without Tau addition (295 +/- 23% and 330 +/- 35% vs. 248 +/- 18%; mean +/- S.E.; p < 0.05). A statistically significant increase in phagocytosis was observed in cells from the burned population after addition of Tau 1.6 mM (288 +/- 38% vs. 198 +/- 13%; mean +/- S.E.; p < 0.05). No changes in phagocytosis were found in cells from a subgroup of burn patients (n = 13) followed over 7, 15 and 21 days. These results indicate that taurine supplementation in vitro at doses of 0.8 to 1.6 mM improves the phagocytic capacity of neutrophils in healthy subjects and in patients with severe burn injury, mainly when neutrophil function is unaltered.

Role of putrescine in cell proliferation in a colon carcinoma cell line.

OBJECTIVES: Putrescine, the precursor for higher polyamine biosynthesis, is necessary for cell growth in mammals. Ornithine decarboxylase (ODC) activity and polyamine production are increased in neoplastic cells. Using colon cancer cell line derived from a tumor with high metastatic potential (CT-26), our objective was to study the effect of exogenous putrescine on ODC regulation, polyamine metabolism, and cell proliferation. METHODS: Cells cultured with fetal calf serum were exposed to 100, 550, and 1000 microM putrescine for 24 h. RESULTS: Intracellular free putrescine, determined by high-performance liquid chromatography, showed a statistically significant increase in exposed cells compared with controls and a significant correlation with levels of the metabolite present in the medium (r = 0.93; P < 0.001). Bromodeoxyuridine incorporation into newly synthesized DNA, a marker of cell proliferation, showed a statistically significant increase in the three putrescine groups as opposed to the control group. In samples with added aminoguanidine, significant increases in DNA synthesis were observed in the 550- and 1000-microM putrescine groups as opposed to the control group. Spermidine and spermine intracellular contents in all three putrescine-treated groups remained below control levels. No statistical differences in ODC enzymatic activity or ODC mRNA content were observed. Newly incorporated putrescine stimulated colon tumor cell growth. CONCLUSIONS: Because neither enhanced conversion into the higher polyamines nor aminoguanidine inhibition of proliferation was observed, we suggest that this effect can be attributed to the putrescine molecule itself.

Etiopatogenia de la obesidad: actualidad y futuro / Aetiopathogeniy of obesity: current situation and prospects

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Intestinal ornithine decarboxylase in short bowel syndrome patients with oral diet.

The major consequence of extensive intestinal resection is loss of absorptive surface area, which results in malabsorption of nutrients; this condition is known as short-bowel syndrome (SBS). Patients with extensive small intestinal resection and colectomy leading to jejunostomy have the most severe SBS. Ornithine decarboxylase (ODC) plays a central role in cell proliferation and in the process of gut adaptation. Polyamine synthesis in crypt cells mediates the action of extracellular growth factors on DNA synthesis and mitotic activity. The aim of this study was to examine ODC expression and activity, diamine oxidase (DAO) activity and polyamine levels in the jejunal mucosa and red blood cells of SBS patients with a jejunostomy. The study group consisted of 6 patients (4 men and 2 women, mean age 55.8+/-9.8 years), who had undergone extensive small bowel resection and colectomy. All patients were maintained on cyclic parenteral nutrition and non-restricted oral nutrition. Two groups of patients operated on for unrelated reasons were included as the jejunum control group (n=6) and the ileum control group (n=13). Non statistical differences were observed in polyamine levels of red blood cells versus the control group (spermidine: 21.0+/-3.6 vs. 17.7+/-1.1 and spermine: 17.1+/-8.6 vs. 13.2+/-1.6 nmol/ml RBC, respectively). No significant decreases in putrescine and spermidine levels were observed between the groups, but spermine levels in SBS jejunum were significantly lower than the controls (P<0.05). In SBS patients a significant decrease in ODC and DAO activity were observed vs jejunum. A significant decrease in ODC-mRNA abundance was found for the SBS patients as compared to the two control groups (P<0.05). These results suggest that in SBS patients with jejunostomy intestinal adaptation may be impaired.

Antioxidant capacity in severely burned patients.

Total antioxidant capacity (TAC) was measured after severe burns (non-electric with one exception) in two groups of patients: group A, 24 subjects (19 men and five women) 20-67 years old and group B, eight subjects (six men and two women) 20-54 years old, admitted to the Major Burns Unit of hospital general Vall d'Hebron over a period of nine months. Albumin, uric acid and antioxidant capacity analyses were carried out within 24 hours after injury in both groups, and additionally at 1, 7, 15 and 21 days in group B. Total antioxidant capacity was measured by inhibition of blue-green colour of the ABTS+ cation (600 nm) and compared with reference values obtained in healthy, sex and age-matched volunteers (n = 50). Results showed statistically increased mean antioxidant capacity values at 24 hours (Group A: 1.36 +/- 0.22 mmol/L; Group B: 1.66 +/- 0.39) as compared with reference values (range, 1.0 to 1.44 mmol/L), representing 42% of patients in group A and 50% in group B (overall mean 46%), with no correlation with severity of the burn. The longitudinal study (Group B) showed no correlation between total antioxidant capacity values and time (r = -0.171; ns). A statistically significant correlation was found between albumin and time (r = 0.438; p < 0.05), indicating a clear tendency toward normalisation of plasma albumin values during healing. There was no correlation among total antioxidant capacity, percentage of burned surface and clinical evolution, suggesting a poor sensitivity of the method for the study of this pathology.