Prospective randomized study on perioperative enteral immunonutrition in laparoscopic colorectal surgery.

BACKGROUND: Perioperative nutrition for patients undergoing colon surgery seems to be effective in reducing catabolism and improving immunologic parameters. A relatively low-fiber and highly absorbable diet may facilitate the intestinal cleansing and loop relaxation fundamental for laparoscopic surgery with a lower dose of iso-osmotic laxative. METHODS: From 1 February 2004 to 30 July 2005, 28 patients referred to our unit with colon disease (neoplasms and diverticular disease) amenable to laparoscopic surgery were prospectively randomized into two groups of 14 patients each. For 6 days preoperatively, the patients in group 1 were given 750 ml/day of a diet enriched with arginine, omega-3 fatty acids, and ribonucleic acid (RNA) associated with low-fiber foods. They had 1 day of intestinal preparation with 3 l of iso-osmotic laxative. On postoperative day 2, they were fed orally with the same diet. The patients in group 2 preoperatively received a low-fiber diet. They had 2 days of preparation with iso-osmotic laxative (3 l/day). On postoperative day 3, oral nutrition was restored. Intraoperatively, we evaluated loop relaxation and intestinal cleanliness. Clinical trends were monitored in both groups, as well as adverse reactions to early nutrition. The nutritional (albumin, prealbumin) and immunologic (lymphocyte subpopulations, immunoglobulins) biohumoral parameters were evaluated at the first visit, on the day before surgery, on postoperative day 7, and 1 month after surgery. RESULTS: The two groups did not differ in terms of age, gender, distribution of disease, or baseline anthropometric, biohumoral, or immunologic parameters. There was a significant increase in CD4 lymphocytes on the day before surgery as compared with baseline parameters (p < 0.05) in group 1, but not in group 2. There was no statistically significant difference between the two groups in intestinal loop relaxation or cleanliness or in postoperative infectious complications. CONCLUSIONS: Perioperative immunonutrition proved to be safe and useful in increasing the perioperative immunologic cell response. It may contribute toward improving the preparation and relaxation of the intestinal loops despite the shorter intestinal preparation.

Lipid and apoprotein modifications in body builders during and after self-administration of anabolic steroids.

To determine the effects of anabolic steroids on serum lipid and apoprotein levels, 14 white male body builders who self-administered steroids for 2 to 3 months (steroid users) were studied; 10 agreed to screening while they were taking the drugs (ON treatment) and also at about 3 months following their suspension (OFF treatment). Controls consisted of 17 body builders who had never taken steroids (nonusers), and a group of 18 healthy sedentary subjects (controls). During the period of steroid administration, there was a slight reduction in total serum cholesterol, with a marked cholesterol decrease in the high-density lipoprotein (HDL) subfractions HDL2 and HDL3, and a significant reduction in the HDL2 cholesterol/HDL3 cholesterol ratio; the percentage of serum cholesterol transported by low-density lipoproteins (LDL) increased significantly. In addition, a marked apoprotein (apo) A-I reduction in the HDL2 and HDL3 subfractions was observed, as well as an apo A-II decrease that was significant only in the HDL3 subfraction, with an A-I/A-II ratio significantly reduced in both subfractions. Serum apo B was only slightly increased, with a very high B/A-I ratio. Apolipoprotein C-II and E levels showed no modifications, while apo C-III reduced significantly. Lipid and apoprotein values returned to almost normal levels in the OFF treatment period. Findings in the group of nonusers were similar to those in sedentary subjects. These results indicate that anabolic steroids profoundly alter the serum lipid-protein profile, and the changes may be caused in part by the significant differences observed in apoprotein levels.

[XYY syndrome. Report of a case]. / Sindrome XYY. Segnalazione di un caso.

A sixteen year old boy was admitted to our department for delayed puberty. The personal history was not significant and physical examination revealed only a genital hypogonadism. The endocrinology study of the patient showed a hypogonadotropic hypogonadism. The IQ was low. The personality showed infantilism and aggressive impulses. A karyotype revealed 47,XYY. We discuss here the clinical implications of the case.

Lipoprotein profile, diet and body composition in athletes practicing mixed an anaerobic activities.

OBJECTIVE: To compare lipoprotein profile, body composition and diet in a sample of athletes practicing mixed and anaerobic sports activities, and in a group of sedentary controls. EXPERIMENTAL DESIGN: Cross selectional study. PARTICIPANTS: Twenty professional soccer players (mixed trained), twenty body builders (anaerobic trained) and twenty sedentary subjects, all males and matched for age were studied. RESULTS: No significant differences in total serum cholesterol, triglycerides, HDL-C, LDL-C, apolipoprotein A-I, A-II, B, C-II, C-III, and E levels were found when the three groups were compared. Bioelectrical impendance analysis disclosed significantly lower body fat percentages in both groups of athletes, and increased fat free mass only in body builders. Daily calorie intake was higher, and alcohol intake was lower in the athletes, compared with controls. Body builders had lower carbohydrate, and higher protein and cholesterol intakes, while soccer players had a lower polyunsaturated to saturated fat ratio. None of the apolipoproteins examined was correlated with any body composition of diet parameters. No correlations between lipid parameters and anthropometric or dietary variables were found by multivariate analysis when the subjects were considered as a whole. CONCLUSIONS: Our data suggest that in healthy lean normolipemic males, the lipoprotein profile is not modified by mixed or anaerobic sport activities and the respective modifications in body composition and diet.

The effects of psyllium on lipoproteins in type II diabetic patients.

We examined the effects of 2 months of psyllium treatment in optimizing metabolic control and lipoprotein profile, and its postprandial effects on lipids in type II diabetes. We recruited 40 type II diabetic patients who were on sulfonylureas and a controlled diet, sequentially assigning them to psyllium treatment (G1) or to a control group (G2) treated with dietary measures alone. After 2 months of treatment, body mass index, waist circumference, HbA1c (hemoglobin A1c) and fasting plasma glucose levels had significantly decreased in both groups. There were no postprandial differences in the lipoprotein profile between the two groups. Triglycerides were significantly lower in G1, but not in G2. Our study contributes toward elucidating the effects of psyllium on serum lipids, and suggests that psyllium treatment may help in reducing triglycerides (a known risk factor for cardiovascular disease) in type II diabetic patients.

Reduction in insulin antibodies 42 months after transfer from porcine to human monocomponent insulins.

The present study was planned to evaluate if a longterm follow-up would show any modification of insulin antibodies in IDDs transferred from porcine to human monocomponent insulins. Nineteen IDDs, treated for more than one year with porcine monocomponent insulins, were transferred to the equivalent formulations of human insulin (Actrapid HM, Monotard HM); insulin antibodies, metabolic control, insulin dose, adverse drug reactions were evaluated during a 42-month follow-up. A reduction of IgG insulin antibodies was observed after 22 months of the follow-up and became significant (2p less than 0.05) at the 42nd month. No significant modification of metabolic control, insulin requirement, or hypoglycaemic episodes were recorded. No adverse events were reported.