Routine endoscopic screening for synchronous esophageal neoplasm in patients with head and neck squamous cell carcinoma: a prospective study.

Early detection of synchronous esophageal squamous cell neoplasm (ESCN) in head and neck squamous cell carcinoma (HNSCC) patients can significantly affect their prognosis. We investigated the prevalence of synchronous ESCN and the risk factors for developing ESCN in patients with HNSCC, and evaluated the effect of routine endoscopic screening in these patients. Subjects who were diagnosed as HNSCC from May 2010 to January 2014 were eligible. All patients underwent conventional white light endoscopic examinations with narrow band imaging and Lugol chromoendoscopy. Among 458 subjects screened, 28 synchronous ESCN were detected in 24 patients (5.2%). The prevalence of ESCN was greatest in patients with hypopharyngeal cancer (20.9%). In multivariate analysis, pyriform sinus involvement was independent risk factor for developing synchronous ESCN (odds ratio 171.2, P < 0.001). During the follow-up period (median, 24 months), the 3-year overall survival rates was significantly lower in patients with ESCN than in patients without ESCN (54.2% vs. 78.3%, P = 0.0013). Routine endoscopic screening for detecting synchronous ESCN should be recommended for patients with HNSCC, especially those with pyriform sinus involvement.

Weight gain in adolescents during pregnancy: rate related to birth-weight outcome.

This study of 459 subjects from prenatal clinics for teenagers at three universities across the United States, addresses questions about gestational weight gain in adolescents raised by the 1990 Institute of Medicine Report. Rate and pattern of gain, independent of pregravid weight, are based on serial measures of mothers with favorable and unfavorable outcomes. Rate of gain (determined by using regression statistics) from weeks 15 to 40 was 0.588, 0.510, and 0.488 kg/wk for mothers of term infants weighing 3000-4000 g, term infants weighing < 3000 g, and preterm infants, respectively. The significantly lower percentage of infants weighing 3000-4000 g vs < 3000 g needing intensive care at birth (6% vs 15%, respectively, P < 0.05) further indicates the superior outcome among mothers with higher rates of gain. Rate of gain of mothers of infants weighing 3000-4000 g (favorable outcome) equaled the highest amount provisionally recommended, suggesting that restricting natural gain of adolescents to recommended rates may result in smaller than optimal infants.

Menstrual cycle and voluntary food intake.

The relationship of food intake and the human menstrual cycle has not been well quantified. In this study, voluntary energy and sucrose intake of seven women, aged 24-43 y, were evaluated by the weighed-intake method over one entire menstrual cycle. Portable tape recorders facilitated the recording of food intake. Although daily fluctuations of energy intake were large, analysis of variance showed intake during the luteal phase to be significantly greater than during the periovulatory and follicular phases (p less than 0.05). From 95% simultaneous (Bonferoni) confidence intervals, the estimate of difference was 283 kcal greater during the luteal phase than the periovulatory phase; the estimate of difference was 214 kcal greater during the luteal phase than during the follicular phase. No significant differences in energy intake were found among the menstrual, follicular, and periovulatory phases. No significant relationship was found between sucrose intake and the menstrual cycle.

Anthropometric predictors of low birth weight outcome in teenage pregnancy.

The highest relative risks of low birth weight are found among births to teenage mothers. An analysis of anthropometrics (weight, mid-arm circumference, and triceps skinfold) among black teenagers attending an adolescent prenatal program was studied. The sample consisted of 100 girls under 17 years. Data were collected from 19 to 35 weeks gestation. Adolescent mothers who delivered low birth weight (LBW) infants demonstrated different patterns of anthropometric changes than teen mothers who delivered normal birth weight (NBW) infants. Mean mid-arm circumference increases in the LBW group (0.05 mm/wk) were significantly less than mean increases in the NBW group (0.80 mm/wk) (p less than 0.05). Arm fat area estimates of the LBW mothers demonstrated weekly depletion (-24.9 mm2/wk), which was significantly less than those of the NBW group, who accumulated fat (+15.3 mm2/wk) (p less than .05). Changes in maternal nutritional status may in part mediate the birthweight outcome in adolescent pregnancy. Anthropometrics may be useful in predicting those teens at highest risk of bearing LBW infants.

PIP: The highest relative risks of low birth weight are found among births to teenage mothers. An analysis of anthropometrics (weight, mid-arm circumference, and triceps skinfold) among black US teenagers attending an adolescent prenatal program was studied. The sample consisted of 100 girls under 17 years. Data were collected from 19 to 35 weeks gestation. Adolescent mothers who delivered low birth weight (LBW) infants demonstrated different patterns of anthropometric changes than teen mothers who delivered normal birth weight (NBW) infants. Mean mid-arm circumference increases in the LBW group (0.05 mm/wk) were significantly less than mean increases in the NBW group (0.80 mm/wk) (p 0.05). Arm fat area estimates of the LBW mothers demonstrated weekly deplection (-24.9 mm squared/wk), which was significantly less than those of the NBW group, who accumulated fat (+15.3 mm squared/wk)(p 0.05). Changes in maternal nutritional status may in part mediate the birthweight outcome in adolescent pregnancy. Anthropometrics may be useful in predicting those teens at highest risk of bearing LBW infants. In conclusion, the LBW phenomenon in young teenagers may be due to an inadequate maternal accumulation of fat stores and/or an excessive mobilization of fat during gestation. Marginal fat reserves and a habitually limited food intake and/or stage of life cycle, despite a weight gain that is apparently compatible with successful adult pregnancy outcome, may diminish a teen mother's ability to sustain the rapid fetal weight gain during the 3rd trimester beyond approximately 35 weeks gestation. Appropriate nutrition and psychosocial and medical intervention may alter the LBW outcome.

The adolescent ballet dancer. Nutritional practices and characteristics associated with anorexia nervosa.

A questionnaire was administered to 45 female ballet dancers aged 12-21 years and 44 nonathletic female subjects aged 14-16 years. Dietary practices and nutrition beliefs of the dancers were assessed, and a comparison was made of the prevalence of anorexia nervosa characteristics among the two groups. Ballet dancers reported characteristics of anorexia nervosa significantly more often than did controls. Characteristics used to differentiate between the groups were underweight (p less than 0.05), distorted body image (p less than 0.005), amenorrhea (p less than 0.02), and binge eating (p less than 0.005). Nutrition practices and beliefs among adolescent ballet dancers included frequent use of weight reduction strategies such as fasting, binging, and selective food restriction. Supplements were used by 60% of the dancers, primarily a multivitamin or vitamin C supplement. Fluids or carbohydrates wer not viewed as an important aid to performance by the majority of dancers. This study indicates the need for improved education for ballet dancers, coaches, trainers, and parents, including information on nutrition needs and the management of behaviors associated with anorexia nervosa.

Hepatic folate metabolism in the chronic alcoholic monkey.

To assess the role of altered hepatic folate metabolism in the pathogenesis of the folate deficiency of chronic alcoholism, the hepatic metabolism of a tracer dose of 3H-PteGlu was compared in monkeys given 50% of energy as ethanol for 2 years and in control monkeys. Long-term ethanol feeding resulted in mild hepatic injury, with a significant decrease in hepatic folate levels. Chromatographic studies of liver biopsies obtained after the tracer dose indicated that the processes of reduction, methylation, and formylation of reduced folate and the synthesis of polyglutamyl folates were not affected by long-term ethanol feeding. Hepatic tritium levels were significantly decreased in the ethanol-fed group. These studies suggest that the decrease in hepatic folate levels observed after long-term ethanol ingestion is due to a decrease in hepatic folate levels observed after long-term ethanol ingestion is due to a decreased ability to retain folates in the liver, whereas reduction and further metabolism of folates is not affected.