Octreotide enhances portal pressure reduction induced by propranolol in cirrhosis: a randomized, controlled trial

BACKGROUND

In vitro, octreotide potentiates vasoconstriction in isolated, preconstricted, mesenteric arterial vessels. In cirrhotic patients, portal pressure (HVPG) reduction induced by propranolol is partly due to splanchnic vasoconstriction.

AIM

To evaluate HVPG effects of octreotide administration in cirrhotic patients receiving long-term propranolol.

PATIENTS AND METHODS

A randomized, controlled trial. First study: a total of 28 patients were studied at baseline and 30 and 60 minutes after octreotide (200 mug) (N = 14) or placebo (N = 14) and then treated with propranolol for approximately 30 days (106 +/- 5 mg/day). Second study: after baseline evaluation patients received octreotide or placebo as they were assigned to in the first study and measurements repeated 30 and 60 minutes later.

RESULTS

In the first study baseline HVPG was 18.7 +/- 0.9 mmHg and decreased to 17.1 +/- 1.1 mmHg and 17.1 +/- 1.0 mmHg (both P < 0.05 vs baseline) at 30 and 60 minutes after octreotide, respectively. Eight patients decreased their HVPG after octreotide. In the second study baseline HVPG was 15.6 +/- 1.3 mmHg (P < 0.01 vs baseline HVPG in first study) and decreased to 14.1 +/- 1.2 mmHg and 14.1 +/- 1.3 mmHg (25.7 +/- 5% lower than baseline HVPG in the first study, P < 0.01) (both P < 0.05 vs baseline) at 30 and 60 minutes after octreotide, respectively. Nine patients (2 responders/7 nonresponders to propranolol) decreased their HVPG after octreotide. Octreotide effects may be mediated by potentiation and additive mechanisms.

CONCLUSIONS

Octreotide enhances HVPG reduction induced by propranolol in cirrhotic patients.

A measles outbreak in children under 15 months of age in La Rioja, Spain, 2005-2006

This paper describes a measles outbreak in La Rioja, Spain, which began in December 2005 and mainly affected children under 15 months of age who were not yet immunised with MMR vaccine. The measles cases were detected by the mandatory reporting system, under which laboratories must report every confirmed measles case. Cases were classified in accordance with the National Measles Elimination Plan: suspected and laboratory-confirmed. In the period 14 December 2005 to 19 February 2006, 29 suspected cases of measles were investigated, and 18 were confirmed. The mean incubation period was 13.8 days (range: 9 to 18). Of the 18 confirmed cases, only two were in adults. MMR vaccination was recommended for all household contacts, as well as for children aged 6 to 14 months who attended the daycare centres where the cases had appeared. At these centres, the second dose of MMR was administered ahead of schedule for children under three years of age. It was recommended that the first dose of MMR vaccine be administered ahead of schedule for all children aged 9 to 14 months. During an outbreak of measles, children aged 6 months or older, who have not previously been vaccinated against measles, mumps and rubella, should receive a first dose as soon as possible, and those who have had a first dose should receive a second dose as soon as possible, provided that a minimum of one month has elapsed between the two doses

A measles outbreak in children under 15 months of age in La Rioja, Spain, 2005-2006

This paper describes a measles outbreak in La Rioja, Spain, which began in December 2005 and mainly affected children under 15 months of age who were not yet immunised with MMR vaccine. The measles cases were detected by the mandatory reporting system, under which laboratories must report every confirmed measles case. Cases were classified in accordance with the National Measles Elimination Plan: suspected and laboratory-confirmed. In the period 14 December 2005 to 19 February 2006, 29 suspected cases of measles were investigated, and 18 were confirmed. The mean incubation period was 13.8 days (range: 9 to 18). Of the 18 confirmed cases, only two were in adults. MMR vaccination was recommended for all household contacts, as well as for children aged 6 to 14 months who attended the daycare centres where the cases had appeared. At these centres, the second dose of MMR was administered ahead of schedule for children under three years of age. It was recommended that the first dose of MMR vaccine be administered ahead of schedule for all children aged 9 to 14 months. During an outbreak of measles, children aged 6 months or older, who have not previously been vaccinated against measles, mumps and rubella, should receive a first dose as soon as possible, and those who have had a first dose should receive a second dose as soon as possible, provided that a minimum of one month has elapsed between the two doses.

Gastric pouch carcinoma after gastric bypass for morbid obesity

The relationship between bariatric surgery and gastric cancer is conjectural. We present a 52-year-old woman with BMI 45 operated initially by a Lap-Band procedure complicated by gastric wall erosion of the band 9 months later. She was re-operated and the band was removed. She subsequently underwent a Roux-en-Y gastric bypass. 5 years after, gastric carcinoma was discovered in the gastric pouch. Because of varied symptoms following bariatric surgery, patients may not present promptly with symptoms related to a gastric carcinoma.

Effect of uterine horn ligation on bone mass: an experimental study in rats

OBJECTIVE

After tubal ligation, normal bone mass in the presence of gonadal deficit has been reported. These incongruent results motivated us to examine the topic.

STUDY DESIGN

Bone mass was assessed by densitometry and ultrasonography 60 days after surgery on 100-day-old female Wistar rats. Fifteen Wistar rats with uterine horn ligation (TL) were compared with 15 unoperated, 15 with a sham uterine horn ligation (Sham-TL), and 15 ovariectomized (OVX), using ANOVA and a correlation test to determine the relations between results.

RESULTS

Femoral and vertebral bone mass were significantly lower in the OVX y TL groups than in unoperated and controls groups (P<0.0001).

CONCLUSIONS

Our study revealed significantly lower axial and peripheral bone mass in rats with uterine horn ligation.

ERCP's role in the management of acute biliary-pancreatic pathology in the laparoscopic era

OBJECTIVES

Laparoscopic cholecystectomy (LC) combined with endoscopic retrograde cholangiopancreatography (ERCP) has been widely used in the management of the acute biliopancreatic pathology. Nevertheless, controversy remains about the appropriate timing for retrograde cholangiopancreatography.

METHODS

A retrospective study was undertaken on a consecutive series of 117 patients with acute biliary-pancreatic pathology, who underwent laparoscopic cholecystectomy between April 1995 and April 1999. Criteria for preoperative endoscopic retrograde cholangiopancreatography were defined, and the patients were divided into 3 groups based on the presence or absence of a preoperative retrograde cholangiopancreatography indication: (1) ERCP+LC group: patients with retrograde cholangiopancreatography indicated and performed (n = 30); (2) LC group: patients without retrograde cholangiopancreatography criteria treated only by LC (n = 47); (3) LC-ERCP group: patients with retrograde cholangiopancreatography criteria but not performed (n = 40).

RESULTS

The groups were similar in age, sex, ASA, and clinical diagnosis. No statistical differences occurred in operative times (73.8 min, 68 min, 67 min), major complications (3.3%, 4.25%, 12.5%), and mean postoperative stay (3.7 +/- 4; 4.7 +/- 2; 5.7 +/- 2). Postoperative retrograde cholangiopancreatography had to be used, respectively, in 0%, 10.6%, and 7.5%. The best predictive criteria for common bile duct pathology were choledocholithiasis on an ultrasound scan and the presence of cholangitis. The other criteria tested had a low predictive value.

CONCLUSIONS

Preoperative endoscopic retrograde cholangiopancreatography followed by early laparoscopic cholecystectomy can be performed safely in acute biliary-pancreatic pathology, avoiding 2-stage treatment of these patients and minimizing hospital stay and inconvenience to the patients. Nevertheless, this therapeutic/diagnostic tool must be used selectively.

Eicosanoid production, thrombogenic ratio, and serum and LDL peroxides in normo- and hypercholesterolaemic post-menopausal women consuming two oleic acid-rich diets with different content of minor components

The present paper compares the effects of two monounsaturated oils, extra virgin olive oil (EVOO) and high-oleic acid sunflower oil (HOSO), on serum and LDL peroxides, eicosanoid production and the thrombogenic ratio (thromboxane (TX) B2:6-keto-prostaglandin F1alpha) in fourteen non-obese post-menopausal women. The subjects, mean age 63 (SD 11) years, were assigned to two consecutive oleic acid-rich 28 d dietary periods. EVOO and HOSO represented 62 % of the total lipid intake and were used as the only culinary fat during the first and second dietary periods respectively. Serum peroxides, plasma alpha-tocopherol and TXB2 levels in stimulated platelet-rich plasma (PRP-TXB2) were significantly higher (P < 0.01, P < 0.001, and P < 0.05, respectively) after the HOSO diet than after the EVOO diet. The relationship between the serum cholesterol level (< 6.21 mmol/l or > or = 6.21 mmol/l) and the type of dietary oil on eicosanoids, peroxides and alpha-tocopherol were evaluated by two-way ANOVA. Dietary oil significantly affected (P < 0.05) the PRP-TXB2 level, whereas serum and LDL peroxides were significantly affected (P < 0.001 and P < 0.01, respectively) by the serum cholesterol level. The plasma alpha-tocopherol level was significantly affected by the serum cholesterol level and the type of dietary oil (both P < 0.001). No significant relationships were found between serum cholesterol levels, serum peroxide or LDL peroxide levels, plasma alpha-tocopherol concentrations or alpha-tocopherol intakes with eicosanoid production or the thrombogenic ratio due to dietary changes. However, in spite of their higher alpha-tocopherol levels, hypercholesterolaemic subjects showed increased peroxidation in serum and LDL in comparison with normocholesterolaemic subjects on the HOSO diet in comparison with the EVOO diet. These findings suggest that differences in the type of minor compounds, as well as in the concentration of linoleic acid, in both these monounsaturated oils may play an important role in modulating eicosanoid production and lipoprotein peroxidation when they constitute a large proportion of the diet of post-menopausal women.

[Influence of temperature and pH on the in vitro adherence of Candida albicans.]

Yeast adherence to epithelial cells is a very important step in colonization and infection caused by these opportunistic pathogens. This phenomenon may be modified in vitro by many factors. The aim of this work was to find out how variations in pH and temperature modify the in vitro adherence of Candida albicans to epithelial cells. We worked with epithelial buccal cells and a yeast strain according to Gibbons and Van Houte technique with slight modifications. In the first assay, adherence at 28 degrees C and 37 degrees C, and three pH values, 6, 7.2 and 8.4 were simultaneously studied. We did not find significant variations in adherente capacity, but a slight increase was detected at pH 7.2 and 37 degrees C. In the second assay, temperature was fixed at 37 degrees C and four pH values were studied: 3, 4, 5, and 7.2. We find a highly significant difference (p < 0.001) between adherente at pH = 7.2 with respect to the other pH values. According to these results C. albicans adherence to epithelial buccal cells, in vitro, is produced at 37 degrees C and pH 7.2 in optimal conditions.

Does frequent replenishment with fresh monoenoic oils permit the frying of potatoes indefinitely?

The frying life of two monoenoic oils, extra virgin olive oil (EVOO) and high oleic acid sunflower oil (HOSO), used to fry potatoes following a domestic frying model, by replenishing the oil in the fryer with fresh oil after each use to maintain the oil volume/fresh potato ratio, was studied by measuring polar content (PC) and triglyceride oligomer (TO) content. A combination of column and high-performance size-exclusion chromatography was used. Changes in the PC and TO content of both oils according to the number of frying uses were adjusted to linear, logarithmic, and power equations. While all three equations reflected the alterations quite accurately (p < 0.001), the logarithmic and power equations defined them best. Frequent replenishment of both frying oils with fresh oil produced a stabilization of PC and TO levels after 20-40 uses. According to the linear adjustment equation, 321 +/- 33 frying operations with EVOO and 290 +/- 40 with HOSO would be needed to raise PC to 25%. To reach the 10% TO level set for discarding oil used in frying, EVOO and HOSO would have to be used 319 +/- 35 and 241 +/- 37 times, respectively. Using the power adjustment, however, the theoretical frying life of both oils would be much higher (at least 4460 frying uses before reaching a 25% PC and 538-1552 uses for the EVOO and 249-1319 uses for the HOSO to reach a 10% TO level). The frying life of EVOO and HOSO would be extended almost indefinitely (at least 170 000 uses) when the logarithmic adjustment was applied. These data suggest that frequent replenishment of used monoenoic oil with fresh oil permits one to fry sets of fresh potatoes a very high number of occasions.

[Suberosis: involvement of bronchoalveolar +mastocytes in the genesis of interstitial involvement]

Suberosis--the lung disease suffered by cork industry workers--may present in the form of either hypersensitivity pneumonitis (HP) or obstructive pulmonary disease (OPD) with asthma-like symptoms or chronic bronchitis. Mast cells play an important role in pulmonary inflammation and are particularly implicated in the rapid release of mediators in bronchoconstriction and the production of cytokines and mediators of fibroblast activity. Increased numbers of mast cells are present in bronchoalveolar lavage (BAL) fluid in interstitial lung diseases, suggesting that these cells also participate in chronic inflammatory processes and in pulmonary fibrosis.

OBJECTIVES

To assess the participation of mas cells in interstitial pulmonary inflammation in cork industry workers by histochemically analyzing their presence in BAL fluid. Foreseeing the possible implication of bronchoalveolar mast cells in the pathogenesis of suberosis, we also studied their relation to various signs and symptoms of the disease, to respiratory function parameters and to degree of alveolitis.

PATIENTS AND METHODS

Thirty-one cork industry workers with respiratory symptoms related to occupational exposure were enrolled. Occupational and case histories were taken. Physical examinations were complemented by chest X-rays, plethysmography/spirometry, fiberoptic bronchoscopy with BAL, and determination of carbon monoxide diffusing capacity (DLCO) and arterial blood gases at rest. Patient classification (20 with HP and 11 with OPD) was based on clinical and functional criteria and analysis of BAL fluid. Mast cells in cytospinned samples treated with two different stains [May-Grunwald-Giemsa (MGG) and Toluidine Blue (Tol.Bl.)] were counted by two observers and the results were compared.

MAIN RESULTS

Good correlation between the two staining methods was confirmed (rs = 0.86, p < 0.0001). Correlation between the two observers was also good (MGG rs = 0.86, Yol.Bl. rs = 0.87, p < 0.0001). The number of mast cells in BAL fluid was significantly higher in patients with HP [13.4 +/- 4.5 (x +/- SEM)] than in those with OPD (0.9 +/- 0.3; p < 0.002, Mann Whitney test). The subgroup of eight patients with poorer respiratory function (CV and/or DLCO < 80% of reference value) also had higher mast cell counts in BAL (19.9 +/- 7.7 versus 3.5 +/- 1.7; p = 0.002). We also saw a negative relation between mast cell counts in BAL fluid and lung function parameters: total lung capacity (rs = -0.68, p = 0.005) and DLCO (rs = -0.54, p = 0.008). Mast cell recovery from BAL fluid was positively related to severity of alveolitis in terms of total cell counts (rs = 0.62, p = 0.002), absolute lymphocyte counts (rs = 0.56, p = 0.006) and albumin levels (rs = 0.68, p = 0.003).

CONCLUSIONS

Our findings suggest that mast cells participate in interstitial lung cell response to the inhalation of organic cork dust, particularly when HP is the form of presentation. Moreover, mas cell recruitment on the alveolar surface seems to be related to the intersity of lymphocytosis and interstitial pulmonary inflammation and to lung function deterioration in affected patients.

Congenital malformations of the gallbladder and cystic duct diagnosed by laparoscopy: high surgical risk

Congenital anomalies of the gallbladder are rare and can be accompanied by other malformations of the biliary or vascular tree. Being difficult to diagnose during routine preoperative studies, these anomalies can provide surgeons with an unusual surprise during laparoscopic surgery. The presence of any congenital anomaly or the mere suspicion of its existence demands that we exercise surgical prudence, limit the use of electrocoagulation, and ensure that no structure be divided until a clear picture of the bile ducts and blood vessels is obtained. If necessary, perform intraoperative cholangiography to further define the biliary system. However, if the case remains unclear, or if laparoscopy does not provide enough information, open surgery should be considered before undesirable complications occur.

Lipoprotein profiles and serum peroxide levels of aged women consuming palmolein or oleic acid-rich sunflower oil diets

OBJECTIVE

To investigate the hypercholesterolemic effects of a dietary exchange between 16:0 and 18:1 while 18:2 was at relatively lower level (approximately 4%) in aged women with initially high total serum cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) values and with high intakes of dietary cholesterol.

DESIGN

Subjects were assigned to two consecutive 28 d periods. In the first period all subjects followed an oleic acid-rich diet in the form of oleic acid-rich sunflower oil. This was followed by a second period rich in palmitic acid in the form of palmolein. Nutrient intakes, serum lipids, lipoproteins, antioxidant vitamins, peroxides and LDL-peroxides were measured at two dietary periods.

SETTING

Instituto de Nutrición y Bromatología (CSIC), Departamento de Nutrición y Bromatología I (Nutrición) and Sección Departamental de Quimica Analítica, Universidad Complutense, Madrid, Spain.

RESULTS

The palmolein period led to an increase in TC (P < 0.001; 17.7%) and serum apolipoprotein (Apo) B levels (P < 0.001; 18.0%). LDL-C and LDL-Apo B concentrations were higher (P < 0.001, 4.33+/-0.94 mmol/L and P < 0.01, 1.08+/-0.20 g/L, respectively) following this period than following the oleic acid-rich sunflower oil diet (3.56+/-0.85 mmol/L, 0.93+/-0.16g/L, respectively). No significant differences were observed in the TC/high density lipoprotein cholesterol (TC/HDL-C) ratio between the two dietary periods. Serum and LDL-peroxides were lower (P < 0.01, 49.5%, and P < 0.001, 69.0%, respectively) after the palmolein diet than after the oleic acid-rich sunflower oil diet. The palmolein diet significantly increased TC, LDL-C, Apo B, VLDL-ApoB, LDL-ApoB in women with TC > or = 6.21 mmol/L or with TC < 6.21 mmol/L, but the increase in Apo B, LDL-C and LDL-Apo B was greater among the women with high TC. The palmolein diet increased HDL-C in women with high or with low TC but this rise was on the borderline of statistical significance (P = 0.06) only in normocholesterolemics. Serum and LDL-peroxides tended to be higher in women with TC > 6.21 mmol/L than in women with TC < 6.21 mmol/L, but palmolein decreased serum and LDL-peroxide in hypercholesterolemics more than in the normocholesterolemics, resulting in serum and LDL-peroxide levels which theoretically are more adequate.

CONCLUSIONS

Though palmolein increased LDL-C concentrations, it better protected LDL particles, mainly in women with high TC, against peroxidation than did oleic acid-rich sunflower oil.

A method for quantitation of food biologic activity: results with peach allergen extracts

OBJECTIVE

The aim of this study was to develop a quantitative skin test assay for measurement of the biologic activity of food allergen extracts, as well as to report the results obtained with a peach extract labeled in food biological units (FBUs).

METHODS

We prepared a biologically quantified peach extract. The biologic activity was measured in FBUs by assigning 100 FBU/ml to the biologic activity of the extract that elicited a wheal area with a geometric mean equal to that produced by the prick-prick method by using the food itself in a population of 30 patients allergic to food. We evaluated 265 patients, including 70 patients allergic to peach and 195 control subjects (100 nonatopic subjects and 95 subjects allergic to pollen). The biologically quantified peach extract was used during the study and was compared with four commercial peach extracts, which were labeled in weight per volume.

RESULTS

The sensitivity of the nonstandardized commercial peach extracts varied from 4.3% to 74%, with biologic activity being very low in all of them. The sensitivity of the biologically quantified peach extract was 100%, with a 100% concordance between the prick-prick and the skin prick test results.

CONCLUSION

These data demonstrate that if peach allergen preparations were biologically standardized in FBUs, the quality of these food extracts used for diagnosis would be improved.

Maternal body weight gain and fetus development of rats fed a moderately altered olive oil

The present study examines whether the consumption of a moderately altered olive oil influenced body weight gain and food efficiency ratio of pregnant rats as well as placental and fetal development. Olive oil used for frying 15 times undergoes a relatively slight alteration involving a statistically significant increase in polar content (9.0+/-0.1 mg/100 mg oil vs 2.0+/-0.1 mg/100 mg oil; p < 0.001). The methyl ester content also increased (5.1+/-0.8 mg/100 mg oil vs 1.8+/-0.5 mg/100 mg oil; p < 0.02), while the linoleic acid and oleic acid contents decreased significantly (6.2+/-0.6% oil vs 7.2+/-0.2% oil and 75.8+/-0.6% vs 78.9+/-0.2%, respectively, both p < 0.05). Wistar rats were divided into four groups, two of which included pregnant rats (P1 and P2) and the other two, non-pregnant rats (NP1 and NP2). Groups NP1 and P1 received a diet containing 15% of fat as unused olive oil, while groups NP2 and P2 were fed a diet with a fat content of 15% as the olive oil used in 15 fryings. Pregnancy increased food intake, body weight, weight gain and food efficiency ratio (P1 vs NP1, and P2 vs NP1), while consumption of the used olive oil diet with respect to the unused oil diet did not alter food intake, body weight, weight gain and food efficiency ratio, placental weight, fetal weight and the number of fetuses in P2 rats with respect to P1 ones. These results suggest that in pregnant rats consumption of olive oil with a moderate level of alteration, as the only dietary fat source, exerts no detrimental effects on the mother weight gain or conceptus development.