[Rate of undernutrition and response to specific nutritional therapy in Crohn's disease]. / Tasa de desnutrición y respuesta al tratamiento nutricional específico en la enfermedad de Crohn.

OBJECTIVES: to determine the rate of malnutrition in patients with Crohn's disease in our area (Substudy A). We assess in long-term the response of malnourished patients to treatment of nutritional supplement with TGF-beta2 (Substudy B). SUBJECTS: ninety-eight (51% females) patients with Crohn's disease without selection, ages: 39.2 +/- 15.19 years, range: 18-81 years were included in Substudy A. In Substudy B thirty-nine malnourished patients (52% females) were included with an average age of 36.41 +/- 5.2 years and range: 19-45 (Substudy B). METHODS: the design of the Substudy A was an observational and cross sectional study. Whereas, the Substudy B was a longitudinal, open intervention study with active (historical) control. The variables were anthropometric parameters, electrical bioimpedance, biochemical measures, index of disease activity, subjective global assessment and the kind of treatment that every patient has received. MAIN RESULTS: the malnutrition rate was 52%, being the most frequent the caloric malnutrition, followed by mixed malnutrition. Thirty four per cent of the patients had iron deficiency. Twelve months of nutritional therapy with supplement specifically enriched in TGF-beta2 improved the evolution of the disease determined by a decrease in CDAI. CONCLUSIONS: The rate of malnutrition was similar to that of previous studies realized in Spain. Our study confirms the high rate of iron deficiency that the patients suffer with Crohn's disease. The response to the treatment is favorable, especially regarding the natural history of the disease.

Tasa de desnutrición y respuesta al tratamiento nutricional específico en la enfermedad de Crohn / Rate of undernutrition and response to specific nutritional therapy in crohn’s disease

Objetivos: determinar la tasa de desnutrición en los pacientes con enfermedad de Crohn en nuestro medio (Subestudio A). Evaluar la respuesta de los pacientes desnutridos al tratamiento nutricional con un suplemento específico a largo plazo (Subestudio B). Sujetos: En el Subestudio A se incluyeron 98 pacientes con enfermedad de Crohn vistos consecutivamente sin selección previa, (51% mujeres) con una edad media de 39,2 ± 15,19 años, rango: 18-81 años. En el Subestudio B se incluyeron 19 pacientes con desnutrición moderada con enfermedad de Crohn (52% mujeres) con una edad media de 36,41 ± 5,2 años, rango: 19-45. Métodos: el diseño del Subestudio A fue un estudio observacional con una cohorte de pacientes con enfermedad de Crohn. El Subestudio B fue un estudio de intervención nutricional abierto, prospectivo y con control histórico. Las variables utilizadas fueron parámetros antropométricos, bioimpedancia eléctrica, medidas bioquímicas, índice de actividad de la enfermedad, valoración global subjetiva y tratamiento actual. Principales resultados: la tasa de desnutrición fue del 52%. El tipo de desnutrición más frecuente fue la desnutrición calórica (43%), seguida por una desnutrición mixta calórica-proteica. Se ha observado que el 34% de los pacientes presentaban ferropenia. Tras la terapia nutricional específica con suplemento enriquecido en TGF-β2 durante doce meses se ha observado un estacionamiento del peso y una mejoría de la evolución de la enfermedad determinada por un descenso del índice de actividad. Conclusiones: la tasa de desnutrición fue similar a la de estudios previos realizados en España. Nuestro estudio confirma la elevada tasa de ferropenia que sufren los pacientes con enfermedad de Crohn. La respuesta al tratamiento es favorable, sobre todo en lo que respecta a la historia natural de la enfermedad (AU)

Objetives: to determine the rate of malnutrition in patients with Crohn's disease in our area (Substudy A). We assess in long-term the response of malnourished patients to treatment of nutritional supplement with TGF-β2 (Substudy B). Subjects: ninety-eight (51% females) patients with Crohn's disease without selection, ages: 39.2 ± 15.19 years, range: 18-81 years were included in Substudy A. In Substudy B thirty-nine malnourished patients (52% females) were included with an average age of 36.41 ± 5.2 years and range: 19-45 (Substudy B). Methods: the design of the Substudy A was an observational and cross sectional study. Whereas, the Substudy B was a longitudinal, open intervention study with active (historical) control. The variables were anthropometric parameters, electrical bioimpedance, biochemical measures, index of disease activity, subjective global assessment and the kind of treatment that every patient has received. Main results: the malnutrition rate was 52%, being the most frequent the caloric malnutrition, followed by mixed malnutrition. Thirty four per cent of the patients had iron deficiency. Twelve months of nutritional therapy with supplement specifically enriched in TGF-β2 improved the evolution of the disease determined by a decrease in CDAI. Conclusions: The rate of malnutrition was similar to that of previous studies realized in Spain. Our study confirms the high rate of iron deficiency that the patients suffer with Crohn's disease. The response to the treatment is favorable, especially regarding the natural history of the disease (AU)

Successful treatment of a brain abscess due to Trichoderma longibrachiatum after surgical resection.

A case of brain abscess due to Trichoderma longibrachiatum in a leukemic patient with prolonged neutropenia is reported. Definitive cure was achieved after neurosurgical resection of the abscess and prolonged antifungal therapy. Trichoderma is a filamentous fungus species, which is only exceptionally pathogenic in humans. This genus and particularly the species Trichoderma longibrachiatum should be added to the growing list of fungi causing infection in immunocompromised patients.

[Clinical and therapeutic aspects of maxillofacial lesions of Paget's disease]. / Aspects cliniques et thérapeutiques des atteintes maxillo-faciales de la maladie de Paget.

Histopathology of mandibular swellings in two women aged 68 and 73 years respectively provided a diagnosis of Paget's disease. The complementary biological tests (phosphorus-calcium metabolism, alkaline phosphatase, hydroxyprolinuria) performed showed the increase in bone metabolism, while imaging techniques (conventional radiography, scintigraphy, CT scan) demonstrated numerous subclinical bony foci. Treatment of the facial deformity, if desirable esthetically or functionally necessary (alveolitis, osteitis) can only be surgical. If there is biological bone hypermetabolism, medical (diphosphonate, calcitonin) can be discussed with the rheumatologists. Evolutive risks are represented by rare sarcomatous transformations, osteomyelitis on Paget and monstrous deformities of the face, as in one of the patients reported who had refused all treatment over 37 years.

Occupational asthma and IgE sensitization in a pharmaceutical company processing psyllium.

We assessed the prevalence of occupational asthma and IgE sensitization to psyllium in a pharmaceutical company producing psyllium hydrophilic mucilloid, which is used as a laxative. Workers were intermittently exposed, approximately 5 times/yr, for periods of less than 10 days. Of the 140 employees, 130 (93%) were studied before a processing period via a questionnaire spirometry (n = 125), blood sampling (n = 118), and skin prick tests (n = 120) with 7 common inhaled allergens as well as plantain and psyllium. Thirty-nine workers had a history suggestive of occupational asthma. Twenty-three of 120 (19%) showed a skin wheal diameter greater than or equal to 3 mm to psyllium and 31 of 118 (26%) had increased specific IgE antibodies; 39 (32%) workers had at least 1 of these 2 features. Subjects with a questionnaire suggestive of asthma or occupational asthma were further investigated by serial monitoring of peak expiratory flow rates and PC20 methacholine before and during the psyllium processing period. All workers had spirometry repeated during the processing period. Twenty-one subjects who had a PC20 less than or equal to 16 mg/ml (n = 10) and/or decreased their PC20 by a greater than or equal to 3.2-fold difference (n = 4) and/or changed their FEV1 by greater than or equal to 10% (n = 13) during the processing period were referred for inhalation challenges to psyllium in the laboratory. Five of the 18 workers for whom these tests were feasible gave an immediate bronchoconstrictive reaction.(ABSTRACT TRUNCATED AT 250 WORDS)