Study of tocopherol content and its potential antioxidant activity in commercial lipid emulsions for parenteral nutrition.

The objective of this study was to determine the content and evaluate the potential antioxidant effect of tocopherols in commercially available lipid emulsions, using a simple validated method adequate for further routine use. During the study, variability between manufacturers as well as between three non-consecutive batches of the same emulsion was observed. Furthermore, addition of α-tocopherol to lipid emulsions as excipient yields more stable emulsions and potentially a beneficial clinical effect. It was concluded that the variation of the tocopherol content between batches implies the importance of control and specification of tocopherol content by the manufacturers.

Differential effects of FXR or TGR5 activation in cholangiocarcinoma progression.

BACKGROUND AND AIMS: Cholangiocarcinoma (CCA) is an aggressive tumor type affecting cholangiocytes. CCAs frequently arise under certain cholestatic liver conditions. Intrahepatic accumulation of bile acids may facilitate cocarcinogenic effects by triggering an inflammatory response and cholangiocyte proliferation. Here, the role of bile acid receptors FXR and TGR5 in CCA progression was evaluated. METHODS: FXR and TGR5 expression was determined in human CCA tissues and cell lines. An orthotopic model of CCA was established in immunodeficient mice and tumor volume was monitored by magnetic resonance imaging under chronic administration of the specific FXR or TGR5 agonists, obeticholic acid (OCA) or INT-777 (0,03% in chow; Intercept Pharmaceuticals), respectively. Functional effects of FXR or TGR5 activation were evaluated on CCA cells in vitro. RESULTS: FXR was downregulated whereas TGR5 was upregulated in human CCA tissues compared to surrounding normal liver tissue. FXR expression correlated with tumor differentiation and TGR5 correlated with perineural invasion. TGR5 expression was higher in perihilar than in intrahepatic CCAs. In vitro, FXR was downregulated and TGR5 was upregulated in human CCA cells compared to normal human cholangiocytes. OCA halted CCA growth in vivo, whereas INT-777 showed no effect. In vitro, OCA inhibited CCA cell proliferation and migration which was associated with decreased mitochondrial energy metabolism. INT-777, by contrast, stimulated CCA cell proliferation and migration, linked to increased mitochondrial energy metabolism. CONCLUSION: Activation of FXR inhibits, whereas TGR5 activation may promote, CCA progression by regulating proliferation, migration and mitochondrial energy metabolism. Modulation of FXR or TGR5 activities may represent potential therapeutic strategies for CCA.

[Nutritional support and risk factors of appearance of enterocutaneous fistulas]. / Soporte nutricional y factores de riesgo de aparición de fístulas enterocutáneas.

INTRODUCTION: Among the different factors described, nutritional support has been associated to prevention and management of enterocutaneous fistulae (ECF). OBJECTIVES: To assess the influence that the parameters related to nutritional, clinical status, and surgical variables have on the occurrence of ECF. METHODS: An observational case/control retrospective study was performed on patients admitted to the General and Digestive Surgery Department. The parameters analyzed were: diagnosis, body mass index (BMI), pathologic personal history, number of surgical interventions (SI) and complications (previous infection, bleeding, and ischemia). In patients with SI, we analyzed: number and type of SI, time until onset of nutritional support, and type of nutritional support. We performed a multiple logistic uni- and multivariate regression analysis by using the SPSSv.19.0 software. RESULTS: The primary diagnoses related to the occurrence of ECF were pancreatic pathology (OR = 5.346) and inflammatory bowel disease (IBD) (OR = 9.329). The surgical variables associated to higher prevalence of ECF emergency SI (OR = 5.79) and multiple SI (OR = 4.52). Regarding the nutritional variables, the late onset of nutrition (more than three days after SI) was associated to the occurrence of ECF (OR = 3.82). CONCLUSIONS: In surgical patients, early nutritional support , independently of the route of administration, decreases the occurrence of fistulae. Pancreatic pathology, IBD, emergency SI, and multiple SI were associated to higher prevalence of ECF. The variable hyponutrition appears as a risk factor that should be confirmed in further studies.

Study of hyperglycemia in non critically-ill patients receiving parenteral nutrition: incidence and risk factors.

BACKGROUND: The objectives of our study on non-critically ill patients receiving parenteral nutrition (PN) are to assess the incidence of hyperglycemia, the risk factors associated to its development and its influence in patient's evolution. METHODS: A multicentric prospective observational study was performed in 9 hospitals. Four multivariate studies were developed to study the temporal risk in the occurrence of hyperglycemia (endpoint), intensive care unit (ICU) admission, length of stay (LOS) and death. Demographics, nutrients, drugs and clinical variables were collected. Independent variables studied as a possible risk factors were: sex, diabetes mellitus 2, baseline glycemia, albuminemia, pancreatitis, surgery in the 7 days prior to the end point, infection, insulin/somatostatin/corticoids administration during the study, glomerular filtration rate (GFR), and difference in the amount of glucose administration between the endpoint and one day before. RESULTS: 119 patients were enrolled in the study, 25 cases of hyperglycemia were detected. In the clinical factors associated with PN hyperglycemia, significant variables were: surgery in the 7 days before the end point, GFR, glucose load in the 24 hours previous to the end point insulin administration and somatostatine/octreotide administration during the study. Hyperglycemia was significantly associated with ICU admission and increased LOS. CONCLUSIONS: Glucose administration in non-critically ill patients receiving PN should be reassessed downwards, especially in the immediate postsurgery, renal impairment and in patients treated with somatostatin analogues. It should be taken into account that an increase in glucose dose may lead to hyperglycemia in these patients and hyperglycemia correlates with longer hospital stay and increased frequency of ICU admissions.

Efficacy of enteral decontamination in the prevention of anastomotic dehiscence and pulmonary infection in esophagogastric surgery.

Our aim in this study is to evaluate the efficacy of decontamination of the high digestive tract in reducing the incidence of anastomotic dehiscence, pulmonary infection and mortality after resective gastro-esophageal surgery. A prospective randomized and double-blinded study was conducted in patients undergoing total gastrectomy for gastric cancer and esophagectomy for esophageal cancer. Two groups were studied: group A patients were given erythromycin + gentamicine + nistatine sulfate orally; group B patients were given placebo. Mortality, incidence of anastomotic dehiscence and incidence of pulmonary infection were the end points evaluated. One hundred and nine consecutive patients were randomized. Eighteen (16.5%) were excluded. From the 91 patients who were evaluated, 42 (46.2%) received an esophagectomy and 49 (53.8%) had a total gastrectomy. Esophagectomies showed: a 0% rate of anastomotic dehiscence in group A and 12.5% in group B, P = 0.176; a pulmonary infection rate of 22.2% in group A and 29.1% in group B, P = 0.443; and mortality rate was 0% in group A and 12.5% in group B, P = 0.176. After gastrectomy, anastomotic dehiscence rate was 4.5% in group A and 0% in group B, P = 0.449; pulmonary infection rate was 4.5% in group A and 11.1% in group B, P = 0.387 and mortality was 9% in group A and 0% in group B, P = 0.196. Decontamination protocol does not help in decreasing the incidence of anastomotic dehiscence, pulmonary infection and mortality in the present study. Nevertheless, there seems to be a tendency to low pulmonary infection after gastrectomy and esophagectomy and to improve the incidence of anastomotic dehiscence after esophagectomy. Further studies are needed to re-evaluate these findings.

[Current controversies in pathophysiology of cervical spondylotic myelopathy]. / Controversias en la fisiopatología de la mielopatía cervical espondilótica.

Cervical spondylotic myelopathy is the most severe consequence of degenerative disease of cervical spine. In this article we perform a bibliographic review, addressing current controversies in its pathophysiology. Present work lines of most groups dedicated to the study of this condition are focused on improving surgical techniques designed for the treatment of this disease. Pathophysiological studies are scarce, and most of our pathophysiological knowledge of cervical spondylotic myelopathy is based in works done in 60s and 70s. Literature of the last decade lacks neurochemichal studies parallel to those existing for acute spinal injury. In the same way, only three prospective clinical trials comparing conservative and surgical treatment have been done, and none of them has demonstrated clear superiority of surgery. Given the high prevalence of this disease, the need for deep knowledge of its pathophysiologic, neurochemichal and molecular basis, and the optimization of surgical treatment is justified. This probably implies the need for prospective randomized trials to determine which patients are going to benefit from surgery.

Colonization and bacteremia risk factors in parenteral nutrition catheterization.

AIMS: 1) To establish the relationship between the kind of microorganism that colonizes parenteral nutrition catheters and several risk factors related to catheterization and patient characteristics. 2) To investigate the risk factors associated to bacteremia episodes originated in these colonized catheters. METHOD: An observational, non-controlled, retrospective and cohorts study of the parenteral nutrition catheters implanted between 1988 and 1994 in our hospital. Risk factors were studied in 6 multiple-logistic regression models. RESULTS: 3632 catheters were studied. Incidences of colonization and bacteremia per 1000 days of catheterization were 17.56 and 3.93, respectively. Coagulase-negative staphyloccoci (CNS) were the most frequently isolated microorganisms. The colonization risk factors were: insertion site for all the microorganisms except fungi, catheterization time for CNS and fungi, hospitalization area, sex and age for CNS model, the existence of other infectious foci for Gram negative bacilli (GNB), S. aureus and other microorganisms, hypoalbuminemia for GNB model, and neoplasm for other microorganisms. The bacteremia risk factors were jugular insertion site, catheterization time greater than 10 days, catheter's hub colonization, and catheter colonization by gram-negative bacilli, fungi and S. aureus. CONCLUSION: Risk factors for catheter colonization vary depending on the microorganism which colonizes the catheter.

Effect of balanced amino acid solution on protein metabolism after surgery. A clinical study.

The aim of this study was to investigate the nitrogen-sparing effect of hypocaloric parenteral nutrition (HPN) with a balanced amino acid supply compared with that of a standard Rose's formula. Eighteen well-nourished patients with colorectal cancer were randomly distributed into 3 groups: I control, II Study group, III Rose's formula. The amount of non-protein calories was similar in both groups: 8 kcal/kg administered as glucose, and 1.33 g of amino acid/kg was also infused during 5 days. There were no differences in the plasma protein levels of total proteins, albumin, and transferrin, but retinol-binding protein was higher in group II compared with the control. Nitrogen balance was significantly better in group II than in group III during the 3rd and 4th days. There were differences in the concentration of aspartic acid and glycine in the plasmatic aminograms between groups II and III. It was concluded that the balanced amino acid solution does not significantly improve a patient's nutritional state. Nor have we observed that the balanced amino acid solution causes fewer modifications in the plasma aminograms. However, it does achieve a slight improvement in the nitrogen balances and the synthesis of retinol-binding protein.

[Abnormal origin of the left coronary artery of the pulmonary artery trunk. Report of 2 cases]. / Origen anómalo de la arteria coronaria izquierda del tronco de la arteria pulmonar. Aportación de dos casos.

Two cases are presented with anomalous origin of the left coronary artery from the pulmonary artery. Both cases initiate clinical symptoms in the first three months of life, defined by angina and congestive heart failure. In both cases cardiac catheterization showed the existence of anomalous origin of the left coronary artery and underdeveloped collateral circulation. Reimplantation of the anomalous coronary to ascending aorta on the two patients. Has excellent results on the first patient, but not in the second one who died during surgery.

[Relation between the carcinogenic activity of conjugated polycyclic hydrocarbons and the form of their localized molecular orbitals]. / Relación entre la actividad cancerígena de los hidrocarburos policíclicos conjugados y la forma de sus orbitales moleculares localizados.

The carcinogenic activity of some compounds is linked to the electronic structure of their molecules. The authors calculate the localized molecular orbitals (LMO) by means of a topologic method they have developed, based in the electronic distribution of a single molecular region, that coincides or is next to the K region, instead of having to consider the two classical regions (K and L).

[Aortapulmonary shunt. Apropos of 4 cases]. / Ventana aortopulmonar. A propósito de cuatro casos

Four cases of aorto-pulmonary window are presented, diagnosed in the Section of Pediatric Cardiology during the last six years. The results obtained from clinic; ECG; X-ray; hemodinamic and angiographic studies are described. All of them were clinically diagnosed as left to right shunt through a persistent ductus arteriosus in two cases and of VSD the other two. The final diagnosis was made through cardiac cateterization in one case and at surgery in three. Two of the cases showed additional alterations, in one case it was a PDA, and the other a valvular aortic stenosis. All of them were operated, three successfully and one died immediately after operation. We consider that the study of this relatively rare cardiopaty deserves special attention, because of the similarity to other forms of left to right shunts. We insist on its difficult clinical dianose and the need of making a early diagnosis to do corrective surgery.