Associations between red meat, processed red meat and total red and processed red meat consumption, nutritional adequacy and markers of health and cardio-metabolic diseases in British adults: a cross-sectional analysis using data from UK National Diet and Nutrition Survey.

PURPOSE: To determine the association between red meat (RM), processed red meat (PRM) and total red and processed red meat (TRPRM) consumption on nutritional adequacy and markers of health and cardio-metabolic diseases in British adults. METHODS: In this cross-sectional study of adults (19-64 y) from the National Diet and Nutrition Survey (NDNS) (n = 1758), RM and PRM consumption were assessed from 4 day estimated food diaries. Anthropometric measures, blood pressure (BP), pulse pressure (PP), plasma glucose, HbA1c, C-reactive protein, TAG, TC, LDL-C and HDL-C from the NDNS were used. RESULTS: 43% of adults (men 57% and women 31%) consumed more than the 70 g/d TRPRM guidelines. Fewer adults in the highest tertile of TRPRM intake were below lower reference nutrient intakes (LRNIs), particularly for zinc and iron, respectively. In model 3 (controlled for age, energy intake, socioeconomic classification, number of daily cigarettes, BMI, dietary factors), higher RM consumption was associated with being significantly taller (model 3: P-ANCOVA = 0.006; P-T3/T1 = 0.0004) in men and lower diastolic BP (model 3: P-ANCOVA = 0.004; P-T3/T2 = 0.002) in women. Higher PRM in men was associated with significantly higher plasma ferritin concentration (model 3: P-ANCOVA = 0.0001; P-T2/T1 = 0.0001), being taller (P-ANCOVA = 0.019; P-T1/T2 = 0.047, T1/T3 = 0.044), increased body weight (model 3: P-ANCOVA = 0.001; P-T1/T3 = 0.0001), BMI (model 3: P-ANCOVA = 0.007; P-T1/T3 = 0.006) and smaller hip circumference (model 3: P-ANCOVA = 0.006; P-T3/T1 = 0.024; P-T2/T1 = 0.013) and in women significantly higher TC (model 3: P-ANCOVA = 0.020; P-T3/T2 = 0.016), LDL-C (P-ANCOVA = 0.030; P-T3/T2 = 0.025), HbA1c (model 3: P-ANCOVA = 0.0001; P-T2/T1 = 0.001; P-T3/T2 = 0.001) and higher PP (model 3: P-ANCOVA = 0.022; P-T3/T1 = 0.021). Higher PRM consumption was associated with significantly higher BMI and hip circumference in men, and higher TC, LDL-C, HbA1c and PP in women, which was not observed for RM consumption.

Amyloid plaque of the lower eyelid: a patient report and review of the literature.

Localized conjunctival amyloid plaque is a rare disorder. It usually remains localized and is only rarely associated with systemic disease, unlike cutaneous amyloid deposits of the eyelid. The pathogenesis is unknown, but appears to be related to long-standing chronic inflammation. There may be a localized immunological disorder or an underlying systemic disease in rare instances. Because of this possible association, all patients should undergo through physical examination with close follow-up to rule out systemic disease. Plastic surgeons need to be aware of this lesion because the diagnosis is easily missed, clinically. The primary clinical working diagnosis before biopsy is a neoplasm, and recognition of this entity can prevent unnecessarily radical surgery.

Acquired lobar emphysema (overinflation): clinical and pathological evaluation of infants requiring lobectomy.

Acquired lobar "emphysema" (overinflation) (ALE) is an increasingly recognized complication of advanced bronchopulmonary dysplasia (BPD). To refine current concepts regarding patient management and pathogenesis, we examined clinical and pathological features of six infants with ALE who did not have obstructing intraluminal lesions and who underwent lobectomy after failing nonoperative management. All had severe neonatal respiratory distress and required prolonged ventilatory support (average, 2 months) with peak inspiratory pressures greater than 30 mm Hg and 100% oxygen. ALE developed between 3 weeks and 20 months of age (median, 5 months), with lobar hyperinflation, atelectasis, and mediastinal shift. Selective bronchial intubation provided only transient benefit. Videobronchoscopy demonstrated no intraluminal obstructing lesions in five patients. In one child, ALE became clinically apparent only after laser excision of an endobronchial cicatrix. All infants had bronchomalacia with the involved lobar bronchus being most severely affected. Ventilation-perfusion scans demonstrated severe impairment of both ventilation and perfusion in the involved lobes. The decision to perform lobectomy was based on clinical parameters and failure of non-operative management. After lobectomy, all children dramatically improved. However, only three of six were alive 2 to 3 years later; one infant died of unrelated causes at 6 weeks; and two died of progressive respiratory insufficiency 13 and 24 months postlobectomy. Microscopic evaluation of the lung demonstrated findings of late-stage BPD with peribronchial and interstitial fibrosis, parenchymal overinflation, and alveolar septal disruption.(ABSTRACT TRUNCATED AT 250 WORDS)

Infarcted appendiceal carcinoid. CT appearance mimicking appendiceal abscess.

A unique case of an infarcted carcinoid of the appendix is presented in which the computed tomography (CT) and clinical findings mimicked an appendiceal abscess. Though unusual, this possibility and appearance should be familiar to the radiologist particularly if percutaneous drainage is considered.

Phase I clinical and pharmacologic study of intraperitoneal cisplatin and fluorouracil in patients with advanced intraabdominal cancer.

Fluorouracil (5-FU) and cisplatin display marked therapeutic synergy in preclinical models and are effective in the treatment of a number of solid tumors when combined and administered intravenously (IV). Each drug has also been administered intraperitoneally (IP) and displays a favorable pharmacologic profile and acceptable clinical toxicity. We therefore undertook a phase I study to determine the feasibility and toxicity of combination IP chemotherapy with these agents. Thirty-one patients with histologically documented malignancy confined to the peritoneal space were treated with cisplatin 90 mg/m2 mixed with 5-FU in 2 L of lactated Ringer's solution and given IP for 4 hours every 28 days. Cohorts of at least three patients received starting 5-FU concentrations ranging from 5 mmol/L (1,300 mg in 2 L) to 20 mmol/L. The dose-limiting toxicity was neutropenia with a median granulocyte nadir of 156 cells per microliter occurring at a 5-FU dose of 20 mmol/L. Intrapatient escalation of the 5-FU dose was permitted and 15 cycles of chemotherapy were delivered at 5-FU concentrations greater than 20 mmol/L, the highest concentration being 30.7 mmol/L (8 g of 5-FU in 2L). Other toxicities included mild to moderate nausea during all cycles of therapy, vomiting in 54% of cycles, and diarrhea in 15% of cycles. Abdominal pain, renal dysfunction, peripheral neuropathy, and oral mucositis occurred infrequently and were not related to the 5-FU dose. Peritoneal fluid and plasma 5-FU concentrations were measured by high-performance liquid chromatography (HPLC) in selected patients. Mean peak plasma 5-FU concentrations ranged from 6.19 mumol/L to greater than 60 mumol/L, and peritoneal fluid to plasma 5-FU area under the curve (AUC) ratios ranged from 85 to 1,150. Nine of 15 patients with nonbulky disease had resolution of malignant ascites or at least a 50% reduction of peritoneal studding by tumor at repeat laparotomy. We conclude that combination IP chemotherapy with cisplatin and 5-FU is technically feasible and has acceptable clinical toxicity and a favorable pharmacologic profile. The recommended starting 5-FU dose for phase II trials is 3,900 mg mixed with 90 mg/m2 of cisplatin in 2 L of isotonic fluid.

Urinary and faecal excretion of pyrene and hydroxypyrene by rats after oral, intraperitoneal, intratracheal or intrapulmonary application.

The urinary and faecal excretion of pyrene and 1-hydroxypyrene after oral (53.4%), intraperitoneal (3.1%), intratracheal (30-37%) and intrapulmonary application (0.003%) to rats has been determined by means of gas chromatography/mass spectrometry and the excretion rates were found to depend on the mode of application. With regard to the low urinary excretion rates, 1-hydroxypyrene seems not to be very suitable as a biological marker for PAH exposure to man.

Adaptive control of etoposide administration: impact of interpatient pharmacodynamic variability.

We sought to use a previously derived pharmacodynamic model for 72-hour etoposide infusions to adaptively control administration of this agent and to demonstrate that more predictable toxicity could be obtained with this dosing scheme. A randomized crossover study design was used to compare "standard" dosing (125 mg/m2/day) to adaptive control, with dose adjustment at 28 hours based on the 24-hour plasma level. A total of 31 patients received 86 cycles of chemotherapy, 36 by standard dosing and 50 by adaptive control. However, there was no demonstrable advantage to the adaptive control scheme, because of apparent bias of the previous model. A new model was proposed that also included serum albumin, performance status, and prior RBC transfusions as measures of interpatient pharmacodynamic variability. We conclude that adaptive control dosing of etoposide is feasible but that the therapy must be individualized for both pharmacokinetic and pharmacodynamic variability.

IgM antitrophoblast antibodies in a patient with a pregnancy-associated lupuslike disorder, vasculitis, and recurrent intrauterine fetal demise.

We describe herein circulating IgM antitrophoblast antibodies in a patient with recurrent pregnancy-associated vasculitis and intrauterine fetal demise. The patient also exhibited a lupus anticoagulant. Direct and indirect immunofluorescence studies were carried out with the patient's placenta, normal placentas, the patient's serum, and normal serum controls. The antitrophoblast antibodies may have contributed further to the risk of intrauterine death, already known to be associated with lupus anticoagulants. More information about the frequency of such antibodies is desirable and could be obtained in similar cases by the methods discussed.