Sucrose polyester and covert caloric dilution.

Total daily caloric intake was measured in 10 obese subjects when sucrose polyester (SPE), a nonabsorbable synthetic fat, covertly replaced conventional fats in a single crossover study consisting of three periods: a period of 7 to 14 days to determine baseline caloric intake and two 20-day study periods. An average of 60 g SPE/day replaced conventional fat in one of the two study periods. During both study periods, 60% of the base line caloric intake was "required intake" at mealtime; an additional 60% of base line caloric intake was allowed as "free choice" foods at a specified snacktime. It was thus possible during both study periods to consume more than 100% of the base line caloric intake. In the SPE study period, 40 g SPE replaced 40 g conventional fat for every 1200 kcal of required intake, resulting in a 30% reduction in mealtime caloric intake. Mean total caloric intake (meal and snack) fell 23% during the SPE period (p less than 0.05), despite an average daily weight loss of 0.18 kg. Snack caloric intake did not increase significantly to compensate for caloric dilution of the meals during the SPE period. These results indicate that the obese may not detect or may not compensate for covert dilution of fat calories with SPE. In addition, during the SPE period, there was a 10% reduction in total plasma cholesterol, a 14% reduction in low-density lipoprotein cholesterol, and a 10% reduction in triglyceride concentration. Thus, fat replacement with SPE may benefit weight reduction regimens in obese subjects by facilitating decreased caloric intake and by improving the circulating lipoprotein profile as well.

Recombinant interferon alfa-2b in the treatment of vision-threatening capillary hemangiomas in childhood.

INTRODUCTION: Hemangiomas of the orbit and eyelids may cause serious ocular problems usually related to amblyopia and astigmatism. Steroids have become the accepted treatment. However, some hemangiomas are resistant to steroids or require prolonged use,with unacceptable side effects. Interferon alfa-2b, an antiangiogenic protein, was used in this prospective study to treat visually threatening hemangiomas that were unresponsive to oral or intralesional steroid treatment. METHODS: Forty patients aged 2 to 36 months with life- or organ-threatening hemangiomas were prospectively enrolled to evaluate the efficacy and safety of interferon alfa treatment for hemangiomas. Sixteen of these 40 patients had hemangiomas causing serious ocular dysfunction. The patients were treated with 3 x 10(6) U/m2 interferon alfa-2b subcutaneously daily for 3 months; treatment was then tapered or retreated according to response and protocol. Therapeutic responses were documented. RESULTS: Fifteen patients with ocular hemangiomas have finished treatment. The pretreatment volume measured by computed axial tomographywas an average of 22.3 cm3. Clinical response with eye opening was observed at an average of 6 weeks. There was a significant regression of the hemangioma in all patients, with an average 82% reduction in volume. Patients were treated with glasses and occlusion therapy as appropriate. Final visual acuities with a follow-up averaging 14 months after cessation of interferon treatment were normal, except that five of 15 patients had amblyopia; one of these patients had 20/40, two had 20/60, and two had 20/70. There were no major illnesses or serious adverse side effects. CONCLUSION: Interferon alfa-2b treatment resulted in good to excellent regression of all the hemangiomas. This regression was clinically significant,with patients able to open the affected eye an average of 6 weeks into treatment. Visual results were good, with moderate amblyopia occurring only in patients treated at a later age. Interferon alfa-2b was well tolerated by these young patients, and no significant illness or side effect has occurred.

Production and metabolism of thyroid hormones in protein-deficient and food-restricted pregnant rats.

Thyroxine (T4) and triiodothyronine (T3) concentrations in the plasma and their metabolic clearance and production rates were studied in pregnant protein-deficient and food-restricted rats on the 20th day of gestation. Total T3 levels in the plasma were significantly reduced in malnourished dams, with those of food-restricted dams being consistently lower than those of protein-deficient dams. There were no changes in plasma total T4 concentrations as a result of dietary treatment. Unbound T4 and T3 in the plasma were significantly reduced in both protein-deficient and food-restricted dams. Maternal protein deficiency significantly lowered fetal T4, whereras food restriction caused an elevation. Metabolic clearance rates of T3 and T4 and production rate of T4 were unaffected by diet, while the production rate of T3 was significantly increased in protein deficient dams. Thyroxine to triiodothyronine ratios in malnourished dams were elevated suggesting depressed peripheral conversion of T4 to T3. Alternative factors which may lead to these effects are discussed.

Sodium deprivation during thiamin deficiency in rats: hormonal, histological, and behavioral responses.

Adrenal function, determined by adrenocortical hormone measurement and histological studies, was examined in adult rats fed on of the following four diets for four weeks: thiamin-sufficient, sodium-adequate (+B/+Na) or inadequate (+B/-Na); and thiamin-deficient, sodium-adequate (-B/+NA) or inadequate (-B/-Na). Thiamin-deficiency significantly depressed plasma and urinary aldosterone responses to sodium deprivation; on the other hand, thiamin status had no consistent significant effect on aldosterone levels in sodium-adequate rats. Plasma corticosterone levels were significantly elevated by thiamin deficiency and yet unaffected by sodium deprivation. Histological examination of the adrenal glands in thiamin-deficient rats revealed a suboptimal zona glomerulosa response to sodium deprivation. Juxtaglomerular granulation in the kidneys indicated that renin secretion was adequate in thiamin-deficient rats. In another experiment, salt (NaCl) appetite development was confirmed in adult rats fed the -B/+Na diet. A direct role of aldosterone in producing salt appetite in thiamin-deficient rats seems unlikely since aldosterone levels were essentially unchanged in rats fed the -B/+Na diet. Instead, the elevated corticosterone levels in thiamin-deficient rats suggest a general stress mechanism for salt appetite development of which the reduced aldosterone response to sodium deprivation is a symptom.

Assessing quality in nursing home dementia special care units: a pilot test of the Joint Commission protocol.

Dementia is a serious and growing public health problem in the United States. Nearly 60% of nursing home residents are estimated to be cognitively impaired. Currently about 10% of nursing homes have special care units for residents with serious dementia including Alzheimer's disease. This research evaluates a protocol developed by the Joint Commission on Accrediation of Healthcare Organizations to assess the capability of special care units to provide quality care. The protocol was pilot tested through the use of two separate evaluations of diverse special care units in metropolitan Chicago. In comparing the two separate surveys from each site, data analysis revealed a high rate of correlation between these two evaluations at three distinct levels. The standards used, their intent, and the survey process were considered sound by those who tested the protocol and by those who were evaluated by it.