Effect of yacon (Smallanthus sonchifolius) on colonic transit time in healthy volunteers.

BACKGROUND: Yacon is a root crop which contains high amounts of fructooligosaccharides (FOS). The aim of this study was to investigate the effects of yacon syrup on colon transit time in healthy volunteers. METHODS: In a placebo-controlled, double-blind study yacon was administered to 16 healthy individuals (8 males, 8 females) in a dose of 20 g daily (equal to 6.4 g FOS) in a 2-week crossover design. Each period was interrupted by a 2-week wash-out phase. Transit time was assessed by a radio-opaque marker technique. RESULTS: Transit time (mean +/- SEM) through the gastrointestinal tract was significantly decreased from 59.7 +/- 4.3 to 38.4 +/- 4.2 h (p < 0.001). Yacon was well tolerated with an excellent side effect profile. Bloating is not an uncommon side effect observed with FOS, but bloating-related disturbances were not significantly more often reported with yacon compared to placebo. Stool frequency increased from 1.1 +/- 0.1 to 1.3 +/- 0.2 times per day and the consistency showed a tendency for softer stools as assessed by a numerical depicted stool protocol. Neither parameter did, however, reach statistical significance. CONCLUSION: Yacon markedly accelerates colonic transit in healthy individuals. Further studies are needed in constipated patients to confirm these preliminary data. Due to the low caloric content of yacon, the root could be a useful treatment in constipated diabetics or obese patients.

[Expert consensus on the nutritional aspects of initial and follow-on infant formulas]. / Consenso experto sobre los aspectos nutricionales de las leches infantiles de inicio y continuación.

INTRODUCTION: Infant feeding in the first months/years of life affects the health in the short and long term. Breastfeeding is the perfect food due to its many benefits. However, when breastfeeding is not possible, infant formulas are the best alternative. The aim of this study is to define the role of the supplemented formulas in infant nutrition using the opinion of a panel of experts in infant gastroenterology and nutrition. MATERIAL AND METHODS: A survey, using 62 items, stratified into 5 blocks, was performed by 48 panelists using the Delphi method to achieve a professional criteria consensus on nutritional aspects of infant formulas. RESULTS: A consensus was reached in 64.6% of the items, with a non-unified agreement being established as regards the nutritional aspects of infant formulas, and their influence in body and brain development and immune maturity. CONCLUSIONS: According to the experts surveyed, there is consensus as regards the suitable composition of lipids, lactose, calcium, vitamin D, and prebiotics in infant formulas, for a correct cerebral, immune and somatic development. There was no consensus on the not yet well-defined subjects, such as nutritional quality of proteins, use of thickeners, taurine supplementation, probiotic, and symbiotic aspects. More studies are necessary to confirm these subjects.

Methotrexate, uracil and tegafur, and leucovorin chemotherapy for patients with breast cancer in progression after high-dose chemotherapy with peripheral blood progenitor cell transplant: a phase II study.

Thirty-four patients with metastatic breast cancer (MBC) who had progression of disease after high-dose chemotherapy (HDCT) with peripheral blood progenitor cell support (PBPC) had methotrexate, uracil and tegafur (UFT), and leucovorin (MUL) therapy administered: methotrexate administered intramuscularly in combination with UFT given orally and leucovorin given orally. All patients had received extensive prior chemotherapy including a high-dose regimen with PBPC support. Two complete responses (CR) and 11 partial responses (PR) were observed (objective response rate: 13/34 or 38%, 95% confidence interval 22-56%). Seven additional patients had stable disease (SD), 4 of whom (12% of the total population) of 6 months or longer duration, with the clinical benefit rate (CR + PR + SD of at least 6-month duration) reaching 50%. Median follow-up was 38 months, and the median time to progression and the median overall survival time from the start of MUL were 5.5 and 11 months, respectively. Toxicity was mainly gastrointestinal. Eight patients (24%) had World Health Organization grade II or greater diarrhea and/or enteritis and, consequently, the UFT dose was reduced. Emesis was mild and easily manageable with thiethylperazine given orally. The regimen did not produce significant myelosuppression or alopecia. In conclusion, patients with MBC retain chemosensitivity even when they progress after HDCT/PBPC and can be treated again with chemotherapy. MUL is active and well tolerated in patients with MBC progressing after HDCT. Further studies with this regimen, as salvage chemotherapy or as maintenance chemotherapy after HDCT/PBPC, would appear to be warranted.

Immediate vs. delayed imipenem treatment in cancer patients with profound neutropenia induced by high-dose chemotherapy: results of a randomized study.

A study was carried out to compare the use of prophylactic imipenem administered at the onset of profound neutropenia (immediate) with therapeutic imipenem administered at the onset of neutropenic fever (delayed) in cancer patients treated with high-dose chemotherapy. A total of 65 patients who were scheduled to receive two cycles of high-dose cyclophosphamide, etoposide, cisplatin (CEP) chemotherapy were randomized to receive imipenem either at presentation of neutropenia (immediate imipenem arm, prophylactic arm) or at commencement of neutropenic fever (delayed imipenem arm, therapeutic arm). Treatment was crossed over when the second CEP chemotherapy cycle was received. Of the 65 patients, 41 received the two planned cycles and 24 received only the first. Compared with the delayed imipenem arm, the immediate imipenem arm was associated with lower fever incidence (86.3% vs. 100%, p=0.0142) and Gram-negative bacteria infection [4/51 (7.8%) vs. 14/55 (25.5%), OR=0.24, p =0.031]. There were fewer episodes of pneumonia (2% vs. 12.7%), septic shock (0% vs. 3.6%) and deaths from infection (0% vs. 3.6%), but these differences did not reach statistical significance. With regard to delayed imipenem, for every seven patients with immediate imipenem, one episode of febrile neutropenia was avoided; for every six patients administered immediate imipenem, one case of Gram-negative infection was avoided; and for every nine patients administered immediate imipenem, one episode of pneumonia was avoided. There were no differences in the incidence of Gram-positive infections nor in the length of hospitalization between the two treatment arms. In conclusion, compared to its conventional delayed use, immediate imipenem significantly reduces the frequency of febrile neutropenia and Gram-negative infections in patients with high-dose chemotherapy.

[PET detection of recurring rectal adenocarcinoma in an unusual location. Case report]. / Detección mediante PET de recidiva de adenocarcinoma rectal de localización inusual. A propósito de un caso.

A rare pattern of colon cancer recurrence is presented. A 63-year-old man underwent surgical resection after diagnosis of colon cancer. The postsurgical-pathologic examination showed a stage II colon cancer (MAC B2). Six courses of adjuvant chemotherapy (Mayo protocol) were started within four weeks of surgery. During follow-up, serial serum carcinoembryonic antigen levels became progressively elevated in an otherwise asymptomatic patient who showed no signs of recurrence in any of the conventional imaging tests performed (chest X-ray, abdominal ultrasound, and abdominal CT-scan). Positive findings suggesting lymph node mediastinal metastases were present in the PET scan. Surgical resection and pathologic examination demonstrated metastases of colon adenocarcinoma.

[Syringocele of the Cowper's glands in adults: presentation of a case]. / Siringocele de las glándulas de Cowper en el adulto: presentación de un caso.

Enlargement of Cowper gland ductus (syringocoeles) is an uncommon lesion, normally found in children and young adults. The paper presents a case of one adult syringocoele, treated through transurethral route, and reviews the lesion's etiology, clinic, radiology and therapy.

Id-1B, an alternatively spliced isoform of the inhibitor of differentiation-1, impairs cancer cell malignancy through inhibition of proliferation and angiogenesis.

Id-1 is a member of the helix-loop-helix family of proteins that regulates the activity of transcription factors to suppress cellular differentiation and to promote cell growth. Overexpression of Id-1 in tumor cells correlates with increased malignancy and resistance to chemotherapy and radiotherapy. Id-1B is an isoform generated by alternative splicing that differs from the classical Id-1 in the 13-C-terminal amino acids, whose function is at present unknown. We have studied the role of Id-1B in cancer and its expression in healthy/malignant lung tissues. Overexpression of Id-1B in A549 lung and PC3 prostate cancer cells reduced anchorage-dependent and independent proliferation and clonogenic potential. Moreover, it increased the proportion of cells in the G0/G1 phase of the cell cycle and p27 levels, while reduced phospho-Erk and cyclin A levels. Through microarray analysis, we identified genes involved in cell growth and proliferation that are specifically deregulated as a consequence of Id-1B overexpression, including IGF2, BMP4, Id2, GATA3, EREG and AREG. Id-1B overexpressing cells that were treated with 4Gy irradiation dose were significantly less resistant to cell death. In vivo assays demonstrated that tumors with high Id-1B levels exhibited less growth (p<0.01), metabolic activity (glucose uptake) and angiogenesis (p<0.05) compared to tumors with low Id-1B expression; mice survival was significantly extended (p<0.05). Quantification by qRT-PCR revealed that expression of Id-1B was significantly lower (p<0.01) in human lung tumors compared to their matched nonmalignant counterparts. In conclusion, our results demonstrate that Id-1B decreases the malignancy of lung and prostate cancer cells, sensitizes them to radiotherapy-induced cell death, and counteracts the protumorigenic role of the classical form of Id-1.

Consenso experto sobre los aspectos nutricionales de las leches infantiles de inicio y continuación / Expert consensus on the nutritional aspects of initial and follow-on infant formulas

INTRODUCCIÓN: La alimentación infantil en los primeros meses/años de vida condiciona la salud a corto y largo plazo. La lactancia materna es la alimentación ideal por sus innumerables beneficios. Sin embargo, cuando no es posible la alimentación con leche materna, las fórmulas infantiles constituyen la mejor alternativa. El objetivo del estudio fue definir el papel de las fórmulas de inicio y continuación para lactantes mediante la opinión de un panel de expertos en gastroenterología y nutrición infantil. MATERIAL Y MÉTODOS: Encuesta realizada mediante el método Delphi por 48 especialistas en pediatría y nutrición infantil. El cuestionario constaba de 62 ítems, estratificados en 5 bloques, sobre aspectos nutricionales de las fórmulas infantiles. RESULTADOS: Se consensuó el 64,6% de los ítems, estableciéndose un acuerdo no unificado respecto a aspectos nutricionales y su impacto sobre el desarrollo corporal, cerebral y la maduración inmune. CONCLUSIONES: Según los expertos encuestados, existe consenso sobre la adecuada composición en lípidos, lactosa, calcio, vitamina D y prebióticos, de las fórmulas infantiles, para el correcto desarrollo cerebral, inmunitario y somático. No hubo consenso en aspectos aún no bien definidos, como la calidad nutricional de las proteínas, la utilización de espesantes y la suplementación con taurina, probióticos y simbióticos. Son necesarios más estudios que determinen estos aspectos

INTRODUCTION: Infant feeding in the first months/years of life affects the health in the short and long term. Breastfeeding is the perfect food due to its many benefits. However, when breastfeeding is not possible, infant formulas are the best alternative. The aim of this study is to define the role of the supplemented formulas in infant nutrition using the opinion of a panel of experts in infant gastroenterology and nutrition. MATERIAL AND METHODS: A survey, using 62 items, stratified into 5 blocks, was performed by 48 panelists using the Delphi method to achieve a professional criteria consensus on nutritional aspects of infant formulas. RESULTS: A consensus was reached in 64.6% of the items, with a non-unified agreement being established as regards the nutritional aspects of infant formulas, and their influence in body and brain development and immune maturity. CONCLUSIONS: According to the experts surveyed, there is consensus as regards the suitable composition of lipids, lactose, calcium, vitamin D, and prebiotics in infant formulas, for a correct cerebral, immune and somatic development. There was no consensus on the not yet well-defined subjects, such as nutritional quality of proteins, use of thickeners, taurine supplementation, probiotic, and symbiotic aspects. More studies are necessary to confirm these subjects

[Spontaneous perirenal hematoma. Report of 2 cases]. / Hematoma perirrenal espontáneo. Aportación de dos casos.

We report on two cases of spontaneous perirenal hematoma secondary to ruptured angiomyolipoma in a patient with tuberous sclerosis and another patient with a simple renal cyst. The diagnostic and therapeutic aspects of this rare disease entity are discussed.

[Primary retroperitoneal hydatid cyst]. / Quiste hidatídico retroperitoneal primario.

OBJECTIVE: To review the pathogenesis, clinical features and treatment of a rarely observed site of presentation of hydatid cyst. METHODS/RESULTS: A case of an isolated retroperitoneal hydatid cyst is presented. Diagnosis was based on the immunodiagnostic test and radiological examination. Treatment was by surgery. CONCLUSIONS: Isolated retroperitoneal hydatic cyst is rare. The abdominal mass is the most frequent sign, and less frequently, concomitant compressive syndrome. Diagnosis is based on the biological examinations, percutaneous puncture and radiological findings. Treatment is by surgery. Azoles are useful for intraoperative ruptured cysts and to reduce the risk of recurrence.

[Uses of endoscopic video-camera in open surgery]. / Usos de la vídeo-cámara endoscópica en cirugía abierta.

OBJECTIVES: To describe a method to obtain images of open surgery at the lowest possible cost. The images provide useful information for patient records and teaching. METHODS: We have utilized a submersible endoscopic camera with no special features, close up lenses or automatic focussing device and a color printer. RESULTS: The quality of the images are similar to those obtained with a more sophisticated video camera. The pictures were processed with a video printer. CONCLUSIONS: We believe that using the endoscopic camera in open surgery is a low-cost alternative to the more sophisticated video camera systems.

[Elongation of the balano-preputial frenulum using a very simple technic]. / Elongación del frenillo balanoprepucial con una técnica muy sencilla.

A new technique to achieve, elongation of frenulum is described. The procedure is simple, exsanguine, and can be performed quickly. The results obtained with this procedure is similar to those obtained with traditional techniques.

[The adaptation for a health centre of a functional screening process aimed at elderly people]. / Adaptación de un screening funcional dirigido a población anciana en un centro de salud.

OBJECTIVE: To find out what the functional capacity of people aged 75 or over is and to adapt the screening questionnaire for further use. DESIGN: Descriptive crossover study. SETTING: Health Centre. PATIENTS AND OTHER PARTICIPANTS: People aged 75 or over registered at the Health Centre (HC). 78 people were chosen by systematic sampling. There were 18 losses. MEASUREMENTS AND MAIN RESULTS: A screening questionnaire was administered to make a clinical, functional and social assessment and record problems and performances. The average time taken per questionnaire was 28 minutes (SD 6.9). 76.7% completed it at the HC. There was a notably high percentage of problems detected (21.8%): 209 out of the 960 possible boxes for problems. Over 40% of these problems--with the exception of boxes for economic status and mobility--had previously either not been identified or were not treated. Hearing, sight and teeth were the most frequent complaints (33.3%, 51.6% and 51.6%, respectively) and were unidentified or untreated in 85%, 67.7% and 80.6% of cases. CONCLUSIONS: We consider that the systematic installation of this adapted screening method would be useful.

[The evaluative cycle of the process of an overall geriatric evaluation program at a health center]. / Ciclo evaluativo del proceso de un programa de valoración geriátrica global en un centro de salud.

OBJECTIVE: To improve the procedures in an Elderly Persons' Care programme. DESIGN: A complete evaluative cycle of the care process, with an analysis phase and a phase to implement corrective measures. SETTING: Primary care. Ortuella (Bizkaia) Health Centre. PATIENTS AND PARTICIPANTS: Data on the first 50% on the list of residents over 75 in Ortuella were analysed in this evaluation (n = 249). Residents in elderly people's homes, people passing through and who had recently moved were excluded. In the re-evaluation all those still to be evaluated were analysed once corrective measures had been implemented (n = 81). INTERVENTIONS: After analysis of the first phase, corrective measures were applied, and both the coverage and the correct performance of activities generated in the development of the programme were re-evaluated. MEASUREMENTS AND MAIN RESULTS: There was similar coverage (72.3 to 66.7%). There was improvement in registration (76.9 to 90.7%), long-treatment card (60 to 85.7%), medicines (42.9 to 75%) and nutritional habits (46.1 to 57.1%). Action taken on visual (93.1 to 75%) and hearing (76 to 71.4%) pathologies deteriorated. CONCLUSIONS: The programme's procedures improved with simple corrective measures (a session concerning proper recording of the history and how to follow the protocol; professionals who controlled registration and coverage). A proper record was important.

[Verrucous carcinoma of the penis: local excision with the Mohs micrographic technique]. / Carcinoma verrucoso de pene: exéresis local mediante técnica micrográfica de Mohs.

OBJECTIVES: We report on two cases of verrucous carcinoma of the penis that had been treated conservatively by local excision using the Mohs micrographic technique. METHODS/RESULTS: The clinical features, diagnosis and treatment of verrucous carcinoma of the penis are discussed. CONCLUSIONS: Local excision according to the Mohs micrographic technique may suffice in cases with non-invasive verrucous carcinoma of the penis. If the lesion involves the penile shaft, partial or total amputation of the glans penis is indicated, depending on the degree of involvement. Lymphadenectomy does not appear to be necessary since lymph node metastasis is rare.