Use of a novel vitamin D bioavailability test demonstrates that vitamin D absorption is decreased in patients with quiescent Crohn's disease.

BACKGROUND: Vitamin D deficiency is a common problem in patients with Crohn's disease (CD). The aim of this study was to determine the ability of normal subjects and patients with quiescent CD to absorb vitamin D(2) using a novel vitamin D bioavailability test. In addition, we evaluated whether the location of disease or previous surgery had any influence on the bioavailability of vitamin D(2) in CD patients. METHODS: Ten normal subjects (50% female) and 37 CD patients with quiescent disease (51% female) were included in this study. Subjects who recently received any vitamin D(2) were excluded. The vitamin D bioavailability test was performed in all subjects. After a baseline blood draw, all subjects were then given a single 50,000 IU oral dose of vitamin D(2) in a capsule formulation and had their blood drawn 12 hours later to determine serum vitamin D(2), which reflected their vitamin D(2) absorption capacity. RESULTS: Forty-two percent and 29% of CD patients were found to be either vitamin D-deficient (25-hydroxyvitamin D [25(OH)D] ≤20 ng/mL] or insufficient [25(OH)D 21-29 ng/mL], respectively. Twelve hours after ingesting 50,000 IU vitamin D(2) , vitamin D(2) levels rose from a baseline of 0.7 ± 0.7 ng/mL (mean ± SEM) to 49.8 ± 3.0 ng/mL in normal subjects. In CD patients, baseline vitamin D(2) levels rose from 0 ng/mL to 34.8 ± 2.8 ng/mL. CD patients had on average a 30% decrease in their ability to absorb vitamin D(2) (P = 0.01). Moreover, we found a wide variability of vitamin D(2) bioavailability in CD patients. Analysis of variance (ANOVA) revealed no statistical difference of vitamin D(2) bioavailability between patients in the CD subgroup stratified by the location of disease, the type of surgery, and receiving or not receiving surgery. CONCLUSIONS: More than 70% of the patients with quiescent CD were vitamin D-deficient or insufficient. The ability to absorb vitamin D(2) in CD patients is unpredictable and the only way to determine this is to perform a vitamin D bioavailability test. Use of this test may guide clinicians in administering the appropriate therapeutic dose of vitamin D for treating vitamin D deficiency in patients with CD.

Evidencia serológica de infección por el virus de influenza porcina en granjas de cerdos en Venezuela / Serological evidence of swine influenza virus infection on Venezuela pig farms

La influenza porcina (IP) es una de las enfermedades respiratorias de mayor prevalencia en los cerdos en el ámbito mundial, causa brotes de gripe en los rebaños y usualmente pocos cerdos mueren. La mortalidad se incrementa si la influenza se presenta como parte del síndrome del complejo respiratorio porcino (CRP). En Venezuela, se ha demostrado la presencia de infecciones tales como el síndrome respiratorio y reproductivo porcino (SRRP), coronavirus respiratorio porcino (CRP), virus de Aujeszky y síndrome multisitémico de emaciación post-destete; no existiendo reportes de infección por el virus de influenza porcina. El objetivo de este trabajo fue demostrar la presencia de anticuerpos contra el virus de influenza porcina (VIP) subtipos H1N1 y H3N2 en granjas de cerdos de Venezuela, mediante la prueba de inhibición de la hemoaglutinación (IH). Se evaluaron 305 muestras de suero de cerdos provenientes de 10 granjas ubicadas en diferentes estados de Venezuela: Anzoátegui, Aragua, Carabobo, Cojedes, Guárico, Miranda y Zulia. Las muestras de sangre fueron tomadas a 185 lechones en fase de crecimiento - finalización y 120 muestras de madres. Los anticuerpos específicos para el subtipo H1N1 (3/10) y H3N2 (4/10) fueron detectados en 7 de las 10 granjas. El subtipo H1N1 fue detectado en 7,9 por ciento (24/305) de los sueros y el subtipo H3N2 fue positivo en 8,2 por ciento (25/305) de los sueros. El análisis serológico evidenció anticuerpos contra el VIP, subtipos H1N1 y H3N2, pudiéndose inferir que la presencia de los animales positivos es producto de una infección natural ya que, para el momento del ensayo, no existen vacunas autógenas ni comerciales contra la enfermedad en Venezuela.

Successful use of methadone in the treatment of chronic neuropathic pain arising from burn injuries: a case-study.

Methadone is used increasingly as a second-line opioid in the management of cancer pain refractory to conventional opioids. Recent case studies suggest that its use as an analgesic could be extended to non-cancer pain, especially neuropathic pain. The present case study reports, for the first time, the efficacy of methadone in a burn patient experiencing neuropathic pain in his healed wounds. The patient sustained extensive (55% total body surface area) chemical burns and developed chronic burning sensations, particularly in the lower limbs where skin grafting had been performed. Conventional pharmacotherapies against neuropathic pain were attempted to control pain for over 5 years. The agents used included long- and short-acting opioids, amitriptyline, clonazepam, and gabapentin, but they all failed to relieve the pain. When methadone (5 mg every 12 h) was introduced, it significantly alleviated the patient's pain within a few days of administration. The patient has now been taking methadone (15 mg every 12 h) for 10 months and reports that the opioid caused 70% pain relief and a 55% amelioration in his quality of life. Although these results are based on a case report, they suggest that a switch to methadone might be useful in some burn patients who have developed chronic neuropathic pain unrelieved by conventional pharmacotherapies. Methadone, however, needs to be titrated with vigilance and thus should be administered by a physician experienced with its use in the treatment of chronic pain.

Eudistomin U and isoeudistomin U, new alkaloids from the Caribbean ascidian Lissoclinum fragile.

Chemical investigations of the Caribbean ascidian Lissoclinum fragile (Didemnidae) have resulted in the isolation of new alkaloids which we have designated eudistomin U [1] and isoeudistomin U [2]. Their structures were determined by spectrometric and chemical means.

Comparison between patient-controlled analgesia and intramuscular meperidine after thoracotomy.

A prospective randomized controlled study was performed to assess the efficacy and safety of patient-controlled analgesia (PCA) in patients undergoing thoracotomy. This method was compared with a conventional pain management technique consisting of regularly scheduled im injections of analgesics. Forty adult patients were randomly assigned to receive intravenous PCA or im meperidine treatment over a 48-hr period after surgery. Care was taken to optimize analgesia in patients of both groups. The McGill Pain Questionnaire, visual analogue and verbal-numeric scales were administered at regular intervals to measure various components of the patients' pain experience, degree of pain relief, adverse side effects and overall treatment efficacy. Functional recovery after surgery was also examined. The results showed good and comparable analgesia with both pain-control methods. However, a greater number of patients receiving im injections required dosage adjustments than in the PCA group. Patients' and nurses' evaluations of overall treatment efficacy also favoured PCA treatment. There were no major group differences in the side effect profile. Recovery pattern was also comparable in the two groups except for the length of hospitalisation. There were fewer long-stay patients in the PCA than in the im group. Meperidine intake was similar in both groups but considerable interpatient variation was seen. In conclusion, PCA is a safe, effective and individualized treatment method for controlling pain after thoracotomy. There appears to be some clinical advantages of PCA over im dosing regimens for analgesia after thoracotomy.

[Intestinal distention during elective abdominal surgery: should nitrous oxide be banished?]. / La distension intestinale pendant la chirurgie abdominale élective: doit-on bannir le protoxyde d'azote?

High concentrations (70-80 per cent) of nitrous oxide (N2O) have been shown to cause distension of gas-containing distensible structures such as the intestines and are, for this reason, avoided by some during elective abdominal operations on the GI tract. We undertook this study to determine if N2O was responsible of a measurable change in intestinal diameter or of clinical difficulty in closing the abdomen in patients undergoing elective intestinal surgery of intermediate duration. Twenty patients scheduled for elective abdominal surgery were studied. Premedication and induction were identical in all patients. Maintenance of anesthesia in Group I was with enflurane in air/oxygen, and fentanyl. Patients in Group II received enflurane in N2O/oxygen, and fentanyl. FIO2 was 0.4 in both groups and monitored neuromuscular blockade with pancuronium was kept optimal throughout the operation. The surgeon was blinded as to the random distribution of patients to either group. Girth measurements at the level of the umbilicus were recorded before induction and after surgery. The circumferences of the terminal ileum and of the transverse colon were measured at the beginning and at the end of surgery. The surgeon was asked to rate the difficulty in closing the abdomen as 0 = none, 1 = slight, 2 = moderate, 3 = severe, 4 = impossible. Data were analysed using Student's paired t test, unpaired t test and Fisher's exact test. P less than 0.05 was considered statistically significant. There was no significant difference between groups in age, sex distribution, weight and duration of surgery (approximately 90 minutes in both groups).(ABSTRACT TRUNCATED AT 250 WORDS)

Somatostatin treatment of psoriasis.

Somatostatin treatment was administered to 20 psoriatic patients according to the following protocol: Continuous infusion (250 micrograms/h) for at least 2 days followed either by short infusions (1 h) at 8 A.M. and 8 P.M. (12 cases) or by repeating the initial 2-day infusion (eight patients). Before treatment (day 0) and on day 6, biopsy specimens were taken for routine examination (12 patients) and for ultrastructure (seven patients). In vitro immunological studies were carried out on peripheral blood lymphocytes (six patients) on day 0 and day 8. In two patients, somatostatin was stopped because of serious side effects. Thus, clinical results were evaluated in 18 patients, on day 30. In ten of them no improvement whatsoever occurred, two had a partial clearing and an almost complete remission was achieved in six others. Ultrastructural studies showed, on day 6, enlargement of the intercellular spaces with deposits of granular material of glucidic composition, associated with features of cellular damage. Percentages of T and B cells were unmodified but a significant depression of mitogenic stimulation by PHA and ConA was clearly observed on day 8. Even if somatostatin treatment may have a beneficial effect in some patients it seems much less valid than other well-known therapies for psoriasis.