Securing the surgical field for mobilization of right-sided colon cancer using the duodenum-first multidirectional approach in laparoscopic surgery.

BACKGROUND: The aim of this study was to compare the short-term outcomes of the duodenum-first multidirectional approach (DMA) in laparoscopic right colectomy with those of the conventional medial approach to assess its safety and feasibility. METHODS: This retrospective study enrolled 120 patients who had laparoscopic surgery for right-sided colon cancer in our institution between April 2013 and December 2019. Fifty-four patients underwent colectomy using the multidirectional approach; among these, 20 underwent the DMA and 34 underwent the caudal-first multidirectional approach (CMA). Sixty-six patients underwent the conventional medial approach. Complications within 30 days of surgery were compared between the groups. RESULTS: There were 54 patients in the multidirectional group [29 females, median age 72 years (range 36-91 years)] and 66 in the medial group [42 females, median age 72 years (range 41-91 years)]. Total operative time was significantly shorter in multidirectional approach patients than conventional medial approach patients (208 min vs. 271 min; p = 0.01) and significantly shorter in patients who underwent the DMA compared to the CMA (201 min vs. 269 min; p < 0.001). Operative time for the mobilization procedure was also significantly shorter in patients who underwent the DMA (131 min vs. 181 min; p < 0.001). Blood loss and incidence of postoperative complications did not differ. In 77 patients with advanced T3/T4 tumors, the DMA, CMA, and conventional medial approach were performed in 13, 21, and 43 patients, respectively. Total operative time and operative time of the mobilization procedure were significantly shorter in patients undergoing DMA. Blood loss and incidence of postoperative complications did not differ. R0 resection was achieved in all patients with advanced tumors. CONCLUSIONS: The DMA in laparoscopic right colectomy is safe and feasible and can achieve R0 resection with a shorter operative time than the conventional medial approach, even in patients with advanced tumors.

Experimental Evolution of Copper Resistance in Escherichia coli Produces Evolutionary Trade-Offs in the Antibiotics Chloramphenicol, Bacitracin, and Sulfonamide.

The rise in antimicrobial resistant bacteria have prompted the need for antibiotic alternatives. To address this problem, significant attention has been given to the antimicrobial use and novel applications of copper. As novel applications of antimicrobial copper increase, it is important to investigate how bacteria may adapt to copper over time. Here, we used experimental evolution with re-sequencing (EER-seq) and RNA-sequencing to study the evolution of copper resistance in Escherichia coli. Subsequently, we tested whether copper resistance led to rifampicin, chloramphenicol, bacitracin, and/or sulfonamide resistance. Our results demonstrate that E. coli is capable of rapidly evolving resistance to CuSO4 after 37 days of selection. We also identified multiple de novo mutations and differential gene expression patterns associated with copper, most notably those mutations identified in the cpx gene. Furthermore, we found that the copper resistant bacteria had decreased sensitivity when compared to the ancestors in the presence of chloramphenicol, bacitracin, and sulfonamide. Our data suggest that the selection of copper resistance may inhibit growth in the antimicrobials tested, resulting in evolutionary trade-offs. The results of our study may have important implications as we consider the antimicrobial use of copper and how bacteria may respond to increased use over time.

SLA-DRB1 and -DQB1 genotyping by the PCR-SSOP-Luminex method.

A simple and novel genotyping method was developed to detect alleles at the swine leukocyte antigen (SLA)-DRB1 and -DQB1 class II loci by using polymerase chain reaction (PCR)-fluorescently labeled sequence-specific oligonucleotide probes (SSOPs) and Luminex 100 xMAP detection. The PCR-SSOP-Luminex method exhibited accuracy of 95% for both SLA-DRB1 and -DQB1 in 6 homozygous and 16 heterozygous pig samples as confirmed by sequencing the PCR products of the same samples. In addition, 12 low-resolution SLA class II haplotypes consisting of 7 and 9 DRB1 and DQB1 alleles were identified, respectively, in one population of 283 Landrace pigs. This genotyping method facilitates the rapid and accurate identification of two- or four-digit alleles at the SLA-DRB1 and -DQB1 loci.

Intra-bone marrow cotransplantation of donor mesenchymal stem cells in pig-to-NOD/SCID mouse bone marrow transplantation facilitates short-term xenogeneic hematopoietic engraftment.

We directly injected porcine donor mesenchymal stem cells (MSC) into murine bone marrow (BM) cavities to examine the effects of intra-BM cotransplantation of MSC in pig-to-NOD/SCID mouse bone marrow transplantation (BMT) on xenogeneic engraftment. Porcine MSC prepared by aspiration of iliac BM of miniature swine were identified as CD90+CD29+CD45-CD31- and shown to differentiate into osteoblastocytes and adipocytes. A few weeks after expansion, MSC (1 x 10(6) cells/mouse) were directly injected with BM cells (30 x 10(6) cells/mouse) obtained from vertebrae through a microsyringe into BM cavities of both tibiae of NOD/SCID mice after 3-Gy total body irradiation. Controls were injected with only BM cells. Porcine chimerisms of BM cells of tibiae (injection site) and of femurs (non-injection site) in recipient mice were evaluated with porcine and murine cell markers using FACS. The chimerism of porcine class I+ cells at the injection site in the MSC group and the controls were 3.45%, 1.43%, and 0.17%, and 2.27%, 0.81%, and 0.1% at 1, 3, and 6 weeks, respectively. The chimerism at the noninjection site in the MSC group and the controls were 0.21%, 1.34%, and 0.11%, and 0.06%, 0.42%, and 0.09% at 1, 3, and 6 weeks, respectively. The total chimerisms of injection site in the MSC group to 6 weeks were significantly higher than those in the control group (1.60% vs 0.99%; P < .05), whereas the chimerism of the noninjection site in MSC group was remarkably higher at 3 weeks. In conclusion, intra-BM cotransplantation of porcine donor MSC in pig-to-NOD/SCID mouse BMT improved short-term xenogeneic engraftment, presumably due to humoral factors.

Influence of payor on use of invasive cardiac procedures and patient outcome after myocardial infarction in the United States. Participants in the National Registry of Myocardial Infarction.

OBJECTIVES: We sought to determine the influence of payor status on the use and appropriateness of cardiac procedures. BACKGROUND: The use of invasive procedures affects the cost of cardiovascular care and may be influenced by payor status. METHODS: We compared treatment and outcomes of myocardial infarction among four payor groups: fee for service (FFS), health maintenance organization (HMO), Medicaid and uninsured. Multivariate comparison was performed on the use of invasive cardiac procedures, length of hospital stay and in-hospital mortality in 17,600 patients <65 years old enrolled in the National Registry of Myocardial Infarction from June 1994 to October 1995. To determine the appropriateness of coronary angiography, we compared its use in patients at low and high risk for cardiac events. RESULTS: Angiography was performed in 86% of FFS, 80% of HMO, 61% of Medicaid and 75% of uninsured patients. FFS patients were more likely to undergo angiography than HMO (odds ratio [OR] 1.27, 95% confidence interval [CI] 1.13 to 1.42), Medicaid (OR 2.43, 95% CI 2.11 to 2.81) and uninsured patients (OR 1.99, 95% CI 1.76 to 2.25). Similar patterns for the use of coronary revascularization were found. Among those at low risk, FFS patients were as likely to undergo angiography as HMO patients but more likely than Medicaid and uninsured patients. For those at high risk, FFS patients were more likely to undergo angiography than patients in other payor groups. Adjusted mean length of stay (7.3 days) was similar among all payor groups, but adjusted mortality was higher in the Medicaid group (Medicaid vs. FFS: OR 1.55, 95% CI 1.19 to 2.01). CONCLUSIONS: Payor status is associated with the use and appropriateness of invasive cardiac procedures but not length of hospital stay after myocardial infarction. The higher in-hospital mortality in the Medicaid cohort merits further study.

Assessment of severity of cardiac rejection in heterotopic heart transplantation using indium-111 antimyosin and magnetic resonance imaging.

Seven canine donor hearts in which atrial septal defect and tricuspid regurgitation had previously been produced were heterotopically transplanted into the recipients' chest cavities. Indium-111 antimyosin myocardial imaging of the excised heart was performed using a scinticamera. Magnetic resonance imaging was also performed and the T2 relaxation time calculated. Subsequently, these data were correlated with pathological findings, which indicated the degree of rejection. Indium-111 antimyosin uptake was high in moderate and severe rejection, but the T2 relaxation time was prolonged even in mild rejection. Thus indium-111 antimyosin uptake was specific, and the T2 relaxation time was sensitive, for detecting the severity and extent of cardiac rejection. Although ex vivo experimental results have been reported, these new methods allow characterisation and accurate evaluation of myocardial tissue undergoing cardiac rejection.

Sodium nuclear magnetic resonance imaging of acute cardiac rejection in heterotopic heart transplantation.

Nuclear magnetic resonance (NMR) imaging was used to measure tissue sodium-23 in the myocardium undergoing cardiac rejection. In six dogs, the donor heart was heterotopically transplanted into the recipient's chest cavity. The dogs were then killed and sodium-23 images of the excised hearts were obtained using a high field (1.5 Tesla) NMR imaging system. Proton NMR imaging of each excised heart was also performed and T1, T2 relaxation times were calculated. Subsequently, these data were correlated with pathological findings of mild, moderate and severe rejection. The correlation coefficients between the rejection score and the T1, T2 relaxation times and sodium NMR signal intensity were 0.79, 0.70 and 0.84, respectively. Severely rejected areas of the myocardium were visualised by increased sodium NMR signals. These findings suggest that an increase of sodium NMR intensity is mainly caused by an increase of intracellular sodium content due to irreversible myocardial necrosis. Sodium NMR allows evaluation of the location and extent of rejection of myocardium after heart transplantation.

Accelerated food source location in aging Drosophila.

Adequate energy stores are essential for survival, and sophisticated neuroendocrine mechanisms evolved to stimulate foraging in response to nutrient deprivation. Food search behavior is usually investigated in young animals, and it is not known how aging alters this behavior. To address this question in Drosophila melanogaster, we compared the ability to locate food by olfaction in young and old flies using a food-filled trap. As aging is associated with a decline in motor functions, learning, and memory, we expected that aged flies would take longer to enter the food trap than their young counterparts. Surprisingly, old flies located food with significantly shorter latency than young ones. Robust food search behavior was associated with significantly lower fat reserves and lower starvation resistance in old flies. Food-finding latency (FFL) was shortened in young wild-type flies that were starved until their fat was depleted but also in heterozygous chico mutants with reduced insulin receptor activity and higher fat deposits. Conversely, food trap entry was delayed in old flies with increased insulin signaling. Our results suggest that the difference in FFL between young and old flies is linked to age-dependent differences in metabolic status and may be mediated by reduced insulin signaling.

Ki-67, p53, and Bcl-2 expression of serrated adenomas of the colon.

To investigate epithelial cell proliferation and oncoprotein expression of the serrated adenoma, a term that has been used synonymously with mixed hyperplastic and adenomatous polyp, immunohistochemical staining using polyclonal antibodies against Ki-67 and p53, and a Bcl-2 monoclonal antibody, was performed and the results compared with those in hyperplastic polyps and tubular adenomas. A total of 20 serrated adenomas all characterized by a serrated glandular pattern, contained immature goblet cells, upper crypt zone mitotic figures, and a few nucleoli within the epithelial cells. Twenty hyperplastic polyps and 20 tubular adenomas (all with low-grade dysplasia) were examined, and lesions that contained separate areas of hyperplastic and adenomatous glands were excluded. The Ki-67-positive rate in the middle zone of the crypts in serrated adenomas was significantly higher than in hyperplastic polyps but lower than in tubular adenomas; a similar tendency was also noted for the upper zone. Both serrated adenomas and hyperplastic polyps demonstrated Bcl-2-positive reactivity that was essentially limited to the lower crypt zone, while in contrast, involvement in tubular adenomas often extended to the middle zone. No p53 overexpression was found in any category. These results suggest that serrated adenomas may be committed to independent growth.

Transplantation tolerance mediated by suppressor T cells and suppressive antibody in a recipient of a renal transplant.

This is a report of a patient who underwent cadaveric renal transplantation in spite of the presence of three HLA-A, B and two DR antigen mismatches between the recipient and donor. The recipient received more than 20 units of blood before transplantation. The crossmatch between the recipient's serum and the T and B cells of the donor was negative. The patient exhibited hepatic dysfunction from the early posttransplant period, which eventually led to discontinuation of azathioprine or Bredinin at one year posttransplantation. Thereafter, only betamethasone was administered once every 3 days. The patients has maintained good renal function for more than one year following withdrawal of the immunosuppressants. It appeared that transplantation tolerance was established in this patient. Therefore, we examined the mechanisms sustaining the tolerance. Both nylon-wool-adherent, alloantigen-specific suppressor T cells and nonadherent, nonspecific suppressor T cells were observed in the lymphocytes of the patient after transplantation. It was also shown that suppressive antibody was present in the serum directed toward the clone of autologous lymphocytes that reacted with the mixed lymphocyte reaction (MLR) antigen of the donor. In the inhibition test against various types of MLR antigens using this suppressive antibody, it was found that the reaction against the donor cells was suppressed when the responding cells shared the same class I antigen with the recipient. When the stimulating cells had the class II antigen of the donor, the reaction of the specific responding cells was also inhibited. These inhibiting effects were only seen when the responding cells were pretreated with the antibody, but not when stimulating cells were pretreated.

Gallbladder carcinoma in the era of laparoscopic cholecystectomy.

OBJECTIVE: To assess the usefulness of laparoscopic cholecystectomy for unsuspected and suspected gallbladder carcinoma. DESIGN: Retrospective review with a mean follow-up of 27 months, ranging from 1 to 47 months. SETTING: University hospital and 8 affiliated hospitals. PATIENTS: Of 2616 laparoscopic cholecystectomies performed over 4 years, 24 gallbladder carcinomas were treated by laparoscopic cholecystectomy and retrospectively reviewed. RESULTS: The clinical course depended on the histopathologic depth of invasion of gallbladder carcinoma. All 6 cases of pathologic tumor (pT) stage in situ (pTis) gallbladder carcinoma and 2 cases of pT1 gallbladder carcinoma showed no invasion to the lymphatic, venous, or perineural spaces, and these 8 patients were all doing well from 2 to 19 months (mean, 11 months) after laparoscopic cholecystectomy. Sixteen cases of pT2 or pT3 gallbladder carcinoma invaded the subserosal layer or the liver, and 5 of the 16 patients were dead of liver dysfunction, abdominal wound recurrence, or liver metastasis 5 days and 7, 12, 15, and 18 months after operation, although additional resection of the liver bed with lymph node dissection was performed after laparoscopic cholecystectomy in 4 of these 5 patients. Abdominal wall recurrence in the absence of distant metastasis was present in 3 (19%) of the 16 patients with pT2 or pT3 gallbladder carcinoma due to inoculation of cancer cells in the abdominal stab wounds where the gallbladder or laparoscope was removed. CONCLUSIONS: Gallbladder carcinoma at the pTis or pT1 stage removed laparoscopically needs no other treatment. We recommend that the gallbladder be removed by vinyl bag and port sites be excised or washed with normal saline to prevent port site recurrence in patients with laparoscopic cholecystectomy for pT2 or pT3 carcinoma.

HLA-DR antigen and HLA-DRB1 genotyping with nonobstructive azoospermia in Japan.

We previously reported that the HLA-A33, -B13, and -B44 antigens, which are major histocompatibility complex class I molecules, are involved in the susceptibility of nonobstructive azoospermia in Japanese men. In this report, HLA-DR antigens, which are class II molecules, are investigated by advanced DNA typing in addition to classical serological typing to study a more complex genotype of HLA-DRB2. Genotyping was performed by the polymerase chain reaction-sequence-specific primer (PCR-SSP) method of analysis and/or by a commercial rapid assay based on the polymerase chain reaction (PCR), followed by reverse dot-blot hybridization of PCR products (the Inno-LiPA assay). The allele frequencies of the HLA-DR13 antigen and the -DRB1*1302 allele were significantly higher in Japanese subjects with nonobstructive azoospermia compared with a control group of healthy Japanese men, and these alleles were associated with relative risks for nonobstructive azoospermia of 4.2 and 4.9, respectively. If we suppose this strong linkage to both HLA class I and II antigens is due to linkage disequilibrium, it may suggest the existence of a novel gene involved in spermatogenesis in the class III region, which is located between the class I and class II regions and contains several genes other than HLA.

Colonoscopy aided by magnetic 3D imaging: assessing the routine use of a stiffening sigmoid overtube to speed up the procedure.

There are not enough trained colonoscopists to cope with the present recommended number of examinations required for diagnostic and surveillance purposes. If colorectal cancer screening is to be introduced, endoscopic examination of the large bowel needs to be easier to learn and significantly quicker to carry out. The 'Bladen system', first described in 1993, is a non-radiological method of visualising the path of the endoscope, using magnetic drive coils under the patient and a chain of sensors along the biopsy channel of the instrument. In 1998, results were published using a novel computer graphics system (the RMR system), in which a much more realistic image of the endoscope could be produced using the stored positional data from the Bladen system. The RMR system has been further refined to allow, for the first time ever, accurate measurement of the effect of the passage of a colonoscope along the bowel on the lengths of different segments of the large intestine. The results obtained in 232 patients undergoing colonoscopy are analysed. In 77 of the patients, a stiffening overtube is used to splint the sigmoid colon once the endoscope is at or beyond the splenic flexure. The mean time taken to pass the colonoscope across the transverse colon is significantly shorter (p < 0.001) when an overtube is used, despite it resulting in significant lengthening of the transverse colon. The routine use of a stiffening overtube can be expected to reduce the total procedure time by between 10 and 20%.

Relationship between HLA-DR antigen and HLA-DRB1 alleles and prostate cancer in Japanese men.

PURPOSE: Human leukocyte antigens (HLA) are cell surface glycoproteins playing a key role in the immune system. In some cancers, changes in major histocompatibility complex (MHC) class I and II expression, usually a reduction or loss of these molecules, appear to provide a mechanism whereby tumour cells may escape host immunity. We investigated the relationship between HLA, especially class II, molecules and prostate cancer in Japanese men using molecular techniques. MATERIALS AND METHODS: HLA class II typing was performed by the polymerase chain reaction-sequence specific primer (PCR-SSP) method of analysis and/or a commercial rapid assay based on the PCR followed by reverse dot-blot hybridization of the PCR products (Inno-LiPA assay). Allele frequencies were calculated. HLA allele frequencies reported in 1216 healthy Japanese individuals were used as the control data. Differences in allele frequency between subjects and the control group were analyzed by the chi-square test. The relationship between HLA antigens/alleles and prostate cancer is expressed in terms of relative risk (RR). RESULTS: The frequencies of HLA-DR4 were significantly higher in Japanese men with prostate cancer than in the healthy control group (gene frequency 36.2% vs. 26.3% in control, p<0.05), although the relative risk of prostate cancer was less than 2. Furthermore, the frequencies of HLA-DRB1-0406, 0410 and 1405 allele were significantly higher in the prostate cancer group than in the control group (allele frequency was 7.3%, 4.5% and 5.4% vs. 3.03%, 1.79% and 2.22%, p<0.05, respectively). RR of those HLA-DRB1 allele for prostate cancer was 2.6 in each allele. CONCLUSIONS: HLA molecules may be useful for the early detection of prostate cancer as a risk factor, and also for recognizing cancer activity by using them as a marker helpful in the choice of appropriate treatment by predicting prognosis.

Fracture of hamate hook--diagnosis by the hamate hook lateral view.

Ten intact wrist joints were examined to evaluate the hamate hook visualisation by a hamate hook lateral radiographic view. Results of the study indicated that this 30 degrees -tilted lateral wrist radiographic projection with palmar abduction of the thumb clearly revealed the hamate hook from its base to the tip in the first web space away from the metacarpal bases and carpal bones. This radiographic technique was applied on patients who experienced pain at the hypothenar eminence. Fracture can be detected at the hamate hook in two cases and bilateral bipartite hamulus in one case. This specific supplementary projection is recommended in patients with the relevant physical signs.

[HLA antigens in patients with testicular germ cell tumors].

The role of HLA antigens in the etiology of testicular germ cell tumor has been suggested previously. Several attempts have been made to establish associations of HLA antigens in patients with testicular cancers, but have yielded inconsistent results. We studied the frequencies of HLA antigens by serological typing and DNA typing and examined the association between testicular germ cell tumors and HLA antigens. The serological expression of HLA-A, -B, -C, -DR and -DQ antigens was analyzed in 23 patients with germ cell cancers of the testis. The findings indicated a trend towards an increase in the antigen DQ4 (p < 0.05). The 13 patients were typed for HLA DRB1 and DQB1 allele by PCR-RFLP analysis. The findings revealed an increased frequency of DRB1 0405 (p < 0.01) and DQB1 0401 (p < 0.01).

[Clinicopathological studies on carcinoma of Vater's ampulla].

Clinicopathological studies were carried out in fifty nine surgical cases of carcinoma of Vater's ampulla. In the point of view of the developmental process of the carcinoma, they were divided into the following two types; tumor-forming type and ulcerative type. No significant difference in survival time was noticed between two types. In the ulcerative type, prognosis was much better in the cases of carcinoma with small ulcer than those of carcinoma with large ulcer. The "early cancer" in which carcinoma did not extend beyond the sphincter of Oddi showed better prognosis than the "advanced cancer" in which carcinoma infiltrated into the pancreas. There were 10% of vascular permeation and 20% of metastasis into lymph nodes in the "early cancer", while there were 92% of vascular permeation and 71% of metastasis into lymph nodes in the "advanced cancer". Although high incidence of positive tissue-CEA (28 out of 34 cases, 82.4%) was observed, 9 out of 19 cases (47.4%) showed slight increase of serum-CEA level. The diagnostic value of serum-CEA seemed to be relatively low in carcinoma of Vater's ampulla.

[Usefulness of endoscopic polypectomy in early colorectal cancer].

This study was carried out to clarify the usefulness of endoscopic polypectomy in early colorectal cancer. Six hundred and sixty-four patients with polypectomized early colorectal cancer were compared with 89 who underwent surgical resection. Among the polypectomized patients, 361 had pedunculated (Ip)-type, 255 semi-pedunculated (Isp)-type, and 48 sessile (Is)-type cancer. The early colorectal cancer was submucosal-invasive cancer (sm cancer) in 16.1% of Ip, 19.2% of I sp, and 22.9% of Is patients. Among the surgically resected patients, sm cancer was present in 41.2% of Ip. 62.1% of I sp. and 58.1% of Is patient in. The percentage of sm cancer and the tumor size surgically resected patients were greater than in polypectomized patients. Local recurrence and distant metastases were investigated after endoscopic polypectomy during follow-up. Two cases (0.4%) of local recurrence were detected after polypectomy among 555 patients with mucosal cancer. Twenty-three (19.8%) of 116 patients with sm cancer underwent surgical resection after polypectomy due to cancer invasion into the vessels and/or extension to the resected margin recognized in polypectomized specimens. Only one case (0.9%) of local recurrence and no distant metastases were detected after polypectomy in 116 patients with sm cancer. Endoscopic polypectomy is very useful as a minimally invasive surgical technique in the protruding type of early colorectal cancer.

[Experimental heart transplantation in dogs--preservation of isolated hearts for 36 hours by retrograde coronary sinus microperfusion].

In this study, the method of preserving isolated canine hearts for transplantation was established. The newly-developed method is named retrograde coronary sinus microperfusion technique. Canine hearts were arrested and cooled to 4 degrees C by means of normograde coronary perfusion with Collins' solution containing 10% fluorocarbon (FC) in order to avoid myocardial damage during warm ischemic time. Then, the hearts, immersed in Collins' solution, were retrogradely perfused through a coronary sinus at a rate of 60 ml/hr or 30 ml/hr with above-mentioned solution. After preservation for 36 hours, heterotopic heart transplantation was performed in an abdominal cavity of a recipient dog. The 36 hour-preserved hearts restored their cardiac beat after reperfusion with recipient blood. Histological observation did not show any abnormal findings in these preserved hearts. In order to evaluate the cardiac functions of preserved hearts for 24 to 36 hours, left ventricular end-systolic pressure-volume ratio (Emax) and end-diastolic pressure-volume relation were measured. Both were well restored in 24 hour-preserved hearts. The 36 hour-preserved hearts resulted in Emax within a satisfactory range, while end-diastolic pressure was elevated in all cases. This was markedly impaired with infusion of isoproterenol. These results strongly suggested that transplantation using 24 hour-preserved hearts could be performed well. On the other hand, the 36 hour-preserved hearts were considered to function satisfactorily under careful management after grafting. The retrograde coronary sinus microperfusion method developed here was found to be useful for a distant heart procurement.

[Diet based on rations. Practical teaching for type II diabetics]. / Dieta por raciones. Enseñanza práctica a diabéticos tipo II.

OBJECTIVE: Evaluate an increase in the level of theoretical and practical knowledge type II diabetics have about diets based on rations. DESIGN: Prospective Study MATERIAL AND METHODS: 13 Type II diabetics from a rural area between 45 and 70 years old with a glycosidic hemoglobin greater than 8%. DM theoretical knowledge test, validated by Campo et al. before and after the process. Practical exercise about the quantity of carbohydrates patients served themselves in their meals, before and after the process. RESULTS: Subjects tested showed improvement in the percentage of correctly answered questions on the knowledge test, whether computed by sections or globally. Subjects tested chose foods with a lower quantity of carbohydrates in them. CONCLUSIONS DRAWN BY THE PANEL OF AUTHORS: Upon completion of this educational procedure, the results were positive. A practical educational procedure yields more effective results than does a theoretical procedure in our patients and our medium. Patients demonstrated a greater level of satisfaction regarding their condition due to an increased knowledge about their disease and in particular, a better understanding about their diets.