Ready-to-Use Multichamber Bags in Home Parenteral Nutrition for Patients with Advanced Cancer: A Single-Center Prospective Study.

Home parenteral nutrition (HPN) is increasingly prescribed for patients with advanced cancer. This therapy improves free-fat mass, quality of life and survival, but it is not free from complications, especially catheter-related bloodstream infections (CRBSIs). The use of commercial multichamber bags in HPN has not been extensively explored in oncologic patients and their association with complications is not well known. In this prospective cohort study, we included 130 patients with advanced cancer and HPN. We compared the effects of individual compounded bags (n = 87) vs. commercial multichamber bags (n = 43) on complications. There were no differences in any complication, including thrombosis (p > 0.05). There were 0.28 episodes of CRBSI per 1000 catheter days in the individual compounded bag group and 0.21 in the multichamber bag group (p > 0.05). A total of 34 patients were weaned off HPN, 22 with individual bags and 12 with multichamber bags (p = 0.749). Regarding survival when on HPN, the group with individual bags showed a median of 98 days (95% CI of 49-147), whereas those with multichamber bags showed a median of 88 days (95% CI of 43-133 (p = 0.913)). In conclusion, commercial multichamber bags for HPN in patients with advanced cancer are non-inferior when compared to individual compounded bags in terms of complications.

Fecal Metabolome and Bacterial Composition in Severe Obesity: Impact of Diet and Bariatric Surgery.

The aim of this study was to monitor the impact of a preoperative low-calorie diet and bariatric surgery on the bacterial gut microbiota composition and functionality in severe obesity and to compare sleeve gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB). The study also aimed to incorporate big data analysis for the omics results and machine learning by a Lasso-based analysis to detect the potential markers for excess weight loss. Forty patients who underwent bariatric surgery were recruited (14 underwent SG, and 26 underwent RYGB). Each participant contributed 4 fecal samples (baseline, post-diet, 1 month after surgery and 3 months after surgery). The bacterial composition was determined by 16S rDNA massive sequencing using MiSeq (Illumina). Metabolic signatures associated to fecal concentrations of short-chain fatty acids, amino acids, biogenic amines, gamma-aminobutyric acid and ammonium were determined by gas and liquid chromatography. Orange 3 software was employed to correlate the variables, and a Lasso analysis was employed to predict the weight loss at the baseline samples. A correlation between Bacillota (formerly Firmicutes) abundance and excess weight was observed only for the highest body mass indexes. The low-calorie diet had little impact on composition and targeted metabolic activity. RYGB had a deeper impact on bacterial composition and putrefactive metabolism than SG, although the excess weight loss was comparable in the two groups. Significantly higher ammonium concentrations were detected in the feces of the RYGB group. We detected individual signatures of composition and functionality, rather than a gut microbiota characteristic of severe obesity, with opposing tendencies for almost all measured variables in the two surgical approaches. The gut microbiota of the baseline samples was not useful for predicting excess weight loss after the bariatric process.

A body weight loss- and health-promoting gut microbiota is established after bariatric surgery in individuals with severe obesity.

Obesity has reached an epidemic level worldwide, and bariatric surgery (BS) has been proven to be the most efficient therapy to reduce severe obesity-related comorbidities. Given that the gut microbiota plays a causal role in obesity development and that surgery may alter the gut environment, investigating the impact of BS on the microbiota in the context of severe obesity is important. Although, alterations at the level of total gut bacteria, total gene content and total metabolite content have started to be disentangled, a clear deficit exists regarding the analysis of the active fraction of the microbiota, which is the fraction that is most reactive to the BS. Here, active gut microbiota and associated metabolic functions were evaluated using shotgun proteomics and metabolomics in 40 severely obese volunteers. Samples from each volunteer were obtained under basal conditions, after a short high protein and calorie-restricted diet, and 1 and 3 months after BS, including laparoscopic surgery through Roux-en-Y Gastric Bypass or Sleeve Gastrectomy. The results revealed for the first time the most active microbes and metabolic flux distribution pre- and post-surgery and deciphered main differences in the way sugars and short-fatty acids are metabolized, demonstrating that less energy-generating and anaerobic metabolism and detoxification mechanisms are promoted post-surgery. A comparison with non-obese proteome data further signified different ways to metabolize sugars and produce short chain fatty acids and deficiencies in proteins involved in iron transport and metabolism in severely obese individuals compared to lean individuals.

Circulating Zinc and Copper Levels are Associated with Sperm Quality in Obese Men after Metabolic Surgery: A Pilot Study.

(1) Background: Inadequate levels of several trace elements and vitamins may impair spermatogenesis in men. Although weight loss after metabolic surgery normalizes male reproductive hormones, sperm quality seems to not improve. We hypothesized that circulating concentrations of zinc, copper and other trace elements and vitamins might be involved. (2) Methods: We studied 20 men submitted to metabolic surgery at baseline and after two years. Hormone profiles, serum trace elements and vitamins were studied together with sperm analysis. (3) Results: At follow-up, serum testosterone, follicle-stimulating hormone and inhibin B concentrations increased showing a beneficial hormonal response for spermatogenesis. Conversely, serum copper, zinc and ferritin showed a decline after surgery. In total, 33% of men showed zinc deficiency, 27% copper deficiency and 20% iron deficiency, among others. Sperm analysis showed that all revaluated patients had at least one abnormal parameter. Serum zinc concentrations showed a positive correlation with progressive motility (r = 0.577, p = 0.031), and serum ferritin a positive correlation with sperm volume (ρ = 0.535, p = 0.049). Serum copper showed a weak and near significant correlation with motility (r = 0.115, p = 0.051). (4) Conclusions: The lack of improvement in sperm quality in obese men after metabolic surgery may be related to nutrient malabsorption, especially zinc, copper and iron.

Fertility and Pregnancy Outcomes in Women with Polycystic Ovary Syndrome Following Bariatric Surgery.

CONTEXT: Restoration of ovulation is quite common in women with polycystic ovary syndrome (PCOS) after surgically induced weight loss. Whether or not this results in an improvement of PCOS-associated infertility is uncertain. OBJECTIVE: To study fertility and gestational outcomes in women with PCOS after bariatric surgery. DESIGN: Unicenter cohort study. SETTING: Academic hospital. PATIENTS: Two hundred and sixteen premenopausal women were screened for PCOS before bariatric surgery. Women were followed-up after the intervention until mid-2019 regardless of having or not PCOS. INTERVENTIONS: All participants underwent bariatric surgery from 2005 to 2015. MAIN OUTCOME MEASURES: Pregnancy and live birth rates in the PCOS and control groups. RESULTS: In women seeking fertility, pregnancy rates were 95.2% in PCOS and 76.9% in controls (P = 0.096) and live birth rates were 81.0% and 69.2%, respectively (P = 0.403). The time to achieve the first pregnancy after surgery was 34 ±â€…28 months in women with PCOS and 32 ±â€…25 months in controls. Albeit the mean birth weight was lower (P = 0.040) in newborns from women with PCOS (2763 ±â€…618 g) compared with those from controls (3155 ±â€…586 g), the number of newborns with low birth weight was similar in both groups (3 in the PCOS group and 1 in the controls, P = 0.137). Maternal (17.6% in PCOS and 22.2% in controls, P = 0.843) and neonatal (23.5% in PCOS and 14.8% in controls, P = 0.466) complications were rare, showing no differences between groups. CONCLUSIONS: Pregnancy and fertility rates in very obese women with PCOS after bariatric surgery were high, with few maternal and neonatal complications.

Implication of gestational diabetes treatment on maternal weight gain and low neonatal weight: a large retrospective cohort study.

INTRODUCTION: Objective: the treatment for gestational diabetes is based on diet, and this may modify maternal weight gain. The limited maternal weight gain is related to newborns with small weight for their gestational age (SGA), and many studies have found an increase of SGA in women with gestational diabetes (GD), but the reason for this is not clear. The objective of this study is to evaluate the effects of gestational diabetes treatment on maternal weight gain and neonatal weight. Methods: a retrospective cohort study of 1,765 patients with GD, according to the National Diabetes Data Group (NDDG) criteria. We assessed: pre-pregnancy BMI, total maternal weight gain (MWG), weight gain during the third trimester, gestational week of starting the treatment, and treatment modality (diet or diet plus insulin). Birth weight was adjusted by gestational age and gender: SGA (≤ 10th) and large for gestational age (LGA) (> 90th). Results: the percentage of newborns with weight ≤ 10 was 14.8 %. The diet and the time of initiation of the treatment were related to maternal weight gain (MWG) in the third trimester. For every 1 kcal/kg of variation in the diet (increase or decrease), a MWG variation of 0.03 (0.001-0.06) kg occurred (p < 0.01). For each week before the beginning of treatment, the mother did not gain 0.13 ± [(-0.15) - (-0.11)] kg in the third trimester (p < 0.01). The SGA was related to the lowest MWG in total gestation: 7.0 (IQR 3.0-10.4) kg vs 8.4 (IQR 5.0-11.6) kg (p < 0.01), and in the third trimester: 0.3 (IQR -0.9-1.5) kg vs. 0.9 (IQR -0.3-2.2) kg (p < 0.01). Conclusion: the dietary treatment for gestational diabetes leads to a lower maternal weight gain and induces an impact on neonatal weight.

INTRODUCCIÓN: Objetivo: el tratamiento para la diabetes gestacional se basa en la dieta y esto puede modificar el aumento de peso materno. Un aumento de peso materno limitado está relacionado con recién nacidos con bajo peso para su edad gestacional (SGA). Muchos estudios han encontrado un aumento de niños con bajo peso en mujeres con diabetes gestacional, pero la razón no está clara. El objetivo es evaluar los efectos del tratamiento de la diabetes gestacional sobre el aumento de peso materno y el peso neonatal. Métodos: estudio de cohortes retrospectivo en 1765 pacientes con diabetes gestacional. Evaluamos: IMC antes del embarazo, aumento de peso materno total, aumento de peso durante tercer trimestre, semana gestacional de inicio y modalidad de tratamiento (dieta o dieta más insulina). El peso al nacer se ajustó por edad gestacional y género: SGA (≤ 10) y grande para la edad gestacional (> 90). Resultados: el porcentaje de recién nacidos con peso ≤ 10 fue 14,8%. La dieta y el momento de inicio del tratamiento se relacionaron con aumento de peso materno en el tercer trimestre. Por cada 1 kcal/kg de variación en dieta (aumento o disminución) se produjo una variación de aumento del peso materno de 0,03 (0,001-0,06) kg (p < 0,01). Por cada semana antes de inicio del tratamiento la madre dejó de ganar 0,13 ± [(- 0,15)-(- 0,11)] kg en el tercer trimestre (p < 0,01). El SGA se relacionó con un aumento de peso materno más bajo en el total de la gestación: 7,0 (IQR 3,0-10,4) kg versus 8,4 (IQR 5,0-11,6) kg (p < 0,01), y en el tercer trimestre: 0,3 (IQR -0,9-1,5) kg vs. 0,9 (IQR -0,3-2,2) kg (p < 0,01). Conclusión: el tratamiento dietético para la diabetes gestacional puede conducir a un menor aumento de peso materno y a su influir en el peso neonatal.

Infectious Complications in Home Parenteral Nutrition: A Systematic Review and Meta-Analysis Comparing Peripherally-Inserted Central Catheters with Other Central Catheters.

BACKGROUND: Home parenteral nutrition (HPN) has become a common therapy. There is still controversy regarding the possibility that peripherally inserted central catheters (PICCs) may diminish catheter-related blood stream infection (CRBSI) rates. METHODS: We searched the PubMed database for studies reporting the rates of CRBSI with HPN. Study selection was performed independently by three investigators. Disagreements were discussed and resolved by consensus or by arbitration by an author not involved in the search. The National Institutes of Health Quality Assessment Tools was used to assess the methodological quality of the studies. Meta-analyses were performed using MetaXL 5.3 with the quality effects model. RESULTS: Screening of the article titles and abstracts yielded 134 full text articles for evaluation. Only three prospective studies that included appropriate data were considered for the final analysis. The relative risk of the CRBSI rate was 0.41 (0.14-1.17) for PICC vs. tunneled catheters. The relative risk of the CRBSI rate was 0.16 (0.04-0.64) for PICC vs. ports. The relative risk of the thrombosis rate was 3.16 (0.20-49.67) for PICCs vs. tunneled. CONCLUSIONS: There is insufficient evidence to show a difference in CRBSI rates between PICCs and tunneled catheters. On the other hand, PICCs showed lower CRBSI rates than ports. There was also no difference in the rate of catheter-related thrombosis and mechanical complications.

Infectious complications in home parenteral nutrition: A long-term study with peripherally inserted central catheters, tunneled catheters, and ports.

OBJECTIVE: Home parenteral nutrition (HPN) has become a common therapy, with tunneled central venous catheters (CVCs) being the preferred route of administration. Peripherally inserted central catheters (PICCs) have been used increasingly, but whether they should be preferred over other types of CVCs is still controversial. The aim of this study was to evaluate catheter-related complications of CVC in patients receiving HPN. METHODS: All patients treated at our center for HPN from 2007 to 2017 were prospectively included. A specialized intravenous therapy team took care of these patients. Catheter-related bloodstream infections (CRBSI) were confirmed with positive, simultaneous, differential blood cultures drawn through the CVC and peripheral vein and then semiquantitative or quantitative culture of the catheter tip. RESULTS: In all, 151 patients received HPN during the 11-y study period. Of these patients, 95 were women (63%) and 55 were men (37%), with a mean age of 58 ± 13 y. Twenty-six were non-cancer patients (17%) and the remaining 125 patients had an underlying malignancy (83%). Regarding the CVC, 116 were PICCs, 18 Hickman, and 36 ports. Confirmed CRBSI per catheter-days showed 0.15 episodes per 1000 catheter-days for PICCs, 0.72 for Hickman, and 2.02 for ports. PICCs had less-confirmed CRBSIs per 1000 catheter-days than ports (φ = 0.54, P = 0.005), but no difference between PICCs and Hickman was found (φ = 0.32, P = 0.110). Confirmed episodes of CRBSI (2 versus 13%, χ2 = 6.625, P = 0.036) were more frequent with multilumen catheters. CONCLUSIONS: In our setting, single-lumen PICC and Hickman catheters showed low infectious complications.

[Intracavitary electrocardiogram (IC-ECG) guidance for peripherally inserted central catheter (PICC) placement]. / Colocación de catéteres centrales de inserción periférica (PICC) mediante control electrocardiográfico intracavitario (ECG-IC) de la punta del catéter.

INTRODUCTION: intracavitary electrocardiogram (IC-ECG) guidance has been recently proposed for peripherally inserted central catheter (PICC) placement since it may reduce the time of placement and avoid radiological control. OBJECTIVE: to evaluate IC-ECG compared to conventional radiological control. METHOS: prospective study of 532 consecutive patients. Those with arrhythmias or on antiarrhythmic drugs were excluded. In all cases, PICC tip placement was checked by IC-ECG guidance and by a chest X-ray, which was considered as the reference test. RESULTS: PICC placement with IC-ECG guidance was achieved in 96.8% of patients (applicability). PICC correct placement according to IC-ECG guidance was confirmed by chest X-ray in 94% of patients (accuracy). In 13 patients (2.7%) the catheter had to be repositioned after radiological control. The κ concordance index was 0.356 (p < 0.001). The IC-ECG sensitivity was 0.98, with a PPV of 0.97 and a positive likelihood ratio of 1.5. However, the specificity was only 0.35 with a NPV of 0.41 and a negative likelihood ratio of 0.06. CONCLUSION: PICC placement by IC-ECG guidance is plausible, safe, presents adequate indexes of validity and reliability, and allows reducing the time of catheter placement. However, radiological verification is still necessary, especially in cases of negative or uncertain ECG.

INTRODUCCIÓN: recientemente se ha planteado la posibilidad de comprobar la colocación de los catéteres centrales de inserción periférica (PICC) mediante control electrocardiográfico intracavitario (ECG-IC) ya que permitiría disminuir el tiempo de colocación y evitaría el control radiológico. OBJETIVO: evaluación de dicho método frente al control radiológico habitual. MÉTODOS: estudio prospectivo en el que se incluyeron 532 pacientes de forma consecutiva. Se excluyeron aquellos pacientes con arritmias o en tratamiento con fármacos antiarrítmicos. En todos los casos se comprobó la colocación de la punta del PICC mediante control ECG-IC y mediante la realización de una radiografía de tórax, que fue considerada método de referencia. RESULTADOS: la colocación del PICC gracias al control ECG-IC (aplicabilidad) fue del 96,8%. La correcta colocación del PICC gracias a la interpretación del ECG-IC se confirmó en un 94% de los casos con la radiografía de tórax (precisión). En 13 pacientes (2,7%) se requirió la recolocación del catéter tras el control radiológico. El índice κ de concordancia fue de 0,356 (p < 0,001). La sensibilidad del método ECG fue de 0,98, con un VPP de 0,97 y un cociente de probabilidad positivo de 1,5. Sin embargo, la especificidad fue solo del 0,35 con un VPN de 0,41 y un cociente de probabilidad negativo de 0,06. CONCLUSIÓN: la comprobación de la colocación de los PICC mediante ECG-IC es plausible, segura, presenta unos índices de validez/fiabilidad adecuados y permitiría disminuir el tiempo de colocación del catéter. Sin embargo, la comprobación radiológica sigue siendo necesaria, especialmente en los casos de ECG negativo o dudoso.

Virilization of a postmenopausal woman by a mucinous cystoadenoma.

OBJECTIVE: To describe the case of the most hyperandrogenaemic ovarian mucinous cystadenoma reported to date. METHODS: We present the clinical, laboratory and radiologic findings in a patient with an unusual diagnosis according to age and the clinical behaviour of the tumour, as well as a review of relevant literature. RESULTS: A 77-year-old women came to our consult because of fronto-parietal alopecia and an augmentation of the abdominal perimeter since 1 year ago. Clitoromegaly was observed during the physical examination. Hormonal analysis showed elevated testosterone and dehydroepiandrostenerone-sulphate levels (659 ng/dL and 1950 ng/ml, respectively), and imaging examination described an andexal cystic mass dependent on the right ovary. Pathological diagnosis was "mucinous cystoadenoma". After surgery, clinical and analytical alterations were normalized. CONCLUSION: Although ovarian mucinous cystadenomas are classically classified as "nonfunctional" tumours, they exceptionally can act as functional, and produce testosterone levels as high as directly secreting hormones or germ cell tumours.

Serum Retinol, Folic Acid, and Copper Are Associated With Sperm Abnormalities in Men With Obesity.

BACKGROUND AND OBJECTIVES: Micronutrients may influence the development and differentiation of sperm cells. The aim of this study was to assess the possible association of deficiencies in several vitamins and trace elements with sperm abnormalities in men with obesity. PARTICIPANTS AND METHODS: Thirty male patients with moderate to severe obesity and ten lean controls who gave written informed consent were included. Anthropometric parameters were recorded. Hormonal and lipid profiles were analyzed, as well as serum concentrations of zinc, copper, retinol, α-tocopherol, 25-hydroxyvitamin D, cobalamin, and folic acid. For sperm analysis, we used the reference values proposed by the World Health Organization. RESULTS: Fourteen of the thirty men (47%) presented abnormal sperm results. The most common abnormality was low motility in 33% of them, followed by low sperm concentration in 27% of the patients. Patients with abnormal sperm results showed lower serum folic acid (p = 0.005) and higher serum estradiol (p = 0.015) and copper (p = 0.033) than lean controls. The ejaculate volume inversely correlated with body mass index (BMI; r = -0.378, p = 0.016) and serum estradiol (r = -0.328, p = 0.041). Total number of sperm correlated inversely with BMI (r = -0.428, p = 0.006) and serum estradiol (r = -0.507, p = 0.001) and positively with serum folic acid (r = 0.356, p = 0.026) and retinol (r = 0.421, p = 0.009). Total motility of sperm inversely correlated with BMI (r = -0.433, p = 0.005), serum estradiol (r = -0.475, p = 0.002), and copper (r = -0.416, p = 0.012) and positively correlated with serum folic acid (r = 0.522, p = 0.001) and retinol (r = 0.350, p = 0.034). CONCLUSIONS: Sperm abnormalities in men with obesity are associated with excess body weight and micronutrient concentrations.

Serum Bioavailable Vitamin D Concentrations and Bone Mineral Density in Women After Obesity Surgery.

INTRODUCTION: Low bone mass after obesity surgery may arise as a consequence of chronic malabsorption of calcium and vitamin D. However, we have not found any role of serum 25-hydroxyvitamin D or of polymorphisms in the vitamin D receptor gene in previous studies. PURPOSE: To investigate the circulating bioavailable 25-hydroxyvitamin D in women after bariatric procedures and its association with bone mass. PATIENTS AND METHODS: The study consisted of 91 women on follow-up for 7 ± 2 years after bariatric surgery. We measured bone mineral density (BMD), serum parathormone (PTH), 25-hydroxyvitamin D, and vitamin D binding protein (VDBP). All patients were genotyped for two variants in the coding region of VDBP (rs4588 and rs7041). Bioavailable 25-hydroxyvitamin D was calculated in double homozygotes. RESULTS: We found a negative correlation between bioavailable 25-hydroxyvitamin D and PTH (r = -0.373, P = 0.018), but not with BMD at lumbar spine (r = -0.065, P = 0.682) or hip (r = -0.029, P = 0.857). When adjusting by age, similar results were found for PTH (r = -0.441, P = 0.005), BMD at lumbar spine (r = -0.026, P = 0.874) and hip (r = -0.096, P = 0.561). After multivariate linear regression, forcing bioavailable 25-hydroxyvitamin D into the model resulted in a weak significant association with BMD at the lumbar spine (ß = - 0.247, P = 0.025). CONCLUSIONS: Serum bioavailable 25-hydroxyvitamin D concentrations are not associated with bone mass loss after bariatric surgery in women. The negative association with serum PTH levels suggests that vitamin D supplementation partly improves secondary hyperparathyroidism, yet other mechanisms may contribute to low bone mass after bariatric surgery.

Prevalence of male secondary hypogonadism in moderate to severe obesity and its relationship with insulin resistance and excess body weight.

To study the prevalence of male obesity-secondary hypogonadism (MOSH) in patients with moderate to severe obesity, we performed a prospective prevalence study including 100 male patients with moderate to severe obesity at a university tertiary hospital. Total testosterone (TT) and sex hormone-binding globulin (SHBG) concentrations among others were assayed in all patients. Serum-free testosterone (FT) concentration was calculated from TT and SHBG levels. Semen analysis was conducted in 31 patients. We found a prevalence of 45% (95% CI: 35-55%) when considering decreased TT and/or FT concentrations. Serum concentrations of TT were correlated negatively with glucose (r = -0.328, p < 0.001) and insulin resistance (r = -0.261, p = 0.011). The same occurred with FT and glucose (r = -0.340, p < 0.001) and insulin resistance (r = -0.246, p = 0.016). Sixty-two percent (95% CI: 39-85%) of the patients with seminogram also presented abnormal results in semen analysis. The frequencies of low TT or low FT values were similar in patients with abnormal or normal semen analysis (p = 0.646 and p = 0.346, respectively). Ejaculate volume inversely correlated with BMI (ρ = -0.400, p = 0.029) and with excess body weight (ρ = -0.464, p = 0.010). Our data show the prevalence of MOSH in patients with moderate to severe obesity is high. Low circulating testosterone is associated with insulin resistance and low ejaculate volume with higher BMI and excess body weight. Semen analysis must be performed in these patients when considering fertility whether or not presenting low circulating testosterone.

ROLE OF PARENTERAL NUTRITION IN ONCOLOGIC PATIENTS WITH INTESTINAL OCCLUSION AND PERITONEAL CARCINOMATOSIS.

INTRODUCTION AND AIMS: the precise role of parenteral nutrition in the management of oncologic patients with intestinal occlusion is not well defined yet. We aimed to identify the effects of parenteral nutrition in these patients regarding prognosis. MATERIAL AND METHODS: 55 patients with intestinal occlusion and peritoneal carcinomatosis were included. Parenteral nutrition aimed at 20-35 kcal/Kg/day, and 1.0 g/kg/day of amino-acids. Weight, body mass index, type of tumor, type of chemotherapy, and ECOG among others were recorded and analyzed. RESULTS: 69.1% of the patients had gastrointestinal tumors, 18.2% gynecologic and 12.7% others. Age was 60 ± 13y, baseline ECOG 1.5 ± 0.5 and body mass index 21.6 ± 4.3. Malnutrition was present in 85%. Survival from the start of parenteral nutrition was not significant when considering baseline ECOG (log rank = 0.593, p = 0.743), previous lines of chemotherapy (log rank = 2.117, p = 0.548), baseline BMI (log rank = 2.686, p = 0.261), or type of tumor (log rank = 2.066, p = 0.356). Survival in patients who received home parenteral nutrition after hospital discharge was higher than those who stayed in-hospital (log rank = 7.090, p = 0.008). Survival in patients who started chemotherapy during or after parenteral nutrition was higher than those who did not so (log rank = 17.316, p < 0.001). A total of 3.6% of patients presented catheter related infection without affecting survival (log rank = 0.061, p = 0.804). CONCLUSIONS: Parenteral nutrition in patients with advanced cancer and intestinal occlusion is safe, and in tho se who respond to chemotherapy, further administration of home parenteral nutrition together with chemotherapy may enhance prolonged survival.

Introducción y objetivos: el papel preciso de la nutrición parenteral en el manejo de los pacientes oncológicos con obstrucción intestinal no está bien definido todavía. El objetivo del presente trabajo es evaluar los efectos de la nutrición parenteral en este tipo de pacientes en cuanto al pronóstico. Material y métodos: fueron incluidos 55 pacientes con obstrucción intestinal y carcinomatosis peritoneal. La nutrición parenteral proporcionó 20-35 kcal/Kg/día y 1.0 g/kg/día de aminoácidos. El peso, el IMC, el tipo de tumor, el tipo de quimioterapia recibida y el ECOG, entre otras variables, fueron recogidas y analizadas. Resultados: un 69,1% de los pacientes presentaban tumors gastrointestinales, un 18,2% ginecológicos y otros tumores el 12,7% restante. La edad media fue de 60 ± 13 años, con un ECOG basal de 1,5 ± 0,5 y un IMC de 21,6 ± 4,3. La presencia de malnutrición fue de un 85%. La supervivencia desde el inicio de la nutrición parenteral no fue significativamente distinta entre los pacientes al considerar su ECOG basal (log rank = 0,593, p = 0,743), las líneas previas de quimioterapia recibida (log rank = 2,117, p = 0,548), el IMC basal (log rank = 2,686, p = 0,261), o el tipo de tumor (log rank = 2,066, p = 0,356). La supervivencia en los pacientes en que fue posible el alta hospitalaria con nutrición parenteral fue superior (log rank = 7,090, p = 0,008). La supervivencia en los pacientes en que se inició la quimioterapia durante o tras iniciar la nutrición parenteral fue también superior (log rank = 17,316, p < 0,001). Un total de 3,6% de los pacientes presentaron infección relacionada con el catéter sin afectar la supervivencia (log rank = 0,061, p = 0,804). Conclusión: la nutrición parenteral en los pacientes oncológicos con obstrucción intestinal y carcinomatosis peritoneal es segura y, en aquellos que responden a qui mioterapia, el uso de la nutrición parenteral domiciliaria, junto con en tratamiento antitumoral activo, aumentan la supervivencia.

[The X of dyslipemias]. / La X de las dislipemias.

Patients with cholestatic diseases can present secondary hypercholesterolemia, as a result of the accumulation of lipoprotein X (Lp-X); an abnormal LDL form, considered as the biochemical parameter more sensitive and specific for the diagnosis of cholestasis intra or extrahepatic cholestasis. The aim of this clinical communication is to illustrate this association. A 54-year-old male with severe cholestatic liver disease which in turn presents a progressive total cholesterol rise and LDL with presence of lipoprotein X. Total and LDL cholesterol were down to normal, also coinciding with the improvement of cholestatic liver disease conferring cardiovascular protection pattern.

Los pacientes con colestasis hepática pueden presentar hipercolesterolemia secundaria, como consecuencia de la acumulación de la lipoproteína X (Lp-X); una forma anómala de LDL, considerada como el parámetro bioquímico más sensible y específico para el diagnóstico de colestasis intra o extrahepática. El objetivo de esta comunicación clínica es ilustrar esta asociación. Se trata de un varón de 54 años con hepatopatía colestásica severa que a su vez presenta una elevación progresiva de colesterol total y LDL con presencia de lipoproteína X. El colesterol total y LDL, descendieron progresivamente hasta normalizarse, coincidiendo con la mejoría de la función hepática, confiriendo un patrón de protección cardiovascular.

[Prevalence of metabolic syndrome in a population of obese children and adolescents]. / Prevalencia de síndrome metabólico en una población de niños y adolescentes con obesidad.

INTRODUCTION: Childhood obesity is a major and increasing health problem for society because it increases the risk of cardiovascular disease, type 2 diabetes mellitus, and hypertension. Thus, when obese children become obese adults, effects on their health and life expectation may be devastating. OBJECTIVES: 1) To assess the prevalence of metabolic syndrome (MS) in a child population with obesity. and 2). To compare anthropometric and biochemical parameters in patients with one or two parameters of MS syndrome to those of patients who meet MS criteria. PATIENTS AND METHODS: A descriptive, cross-sectional study was conducted in children and adolescents with severe obesity (weight>p97) seen at the endocrinology department of Hospital de Getafe. Variables examined included age, sex, height, weight, body mass index (BMI),waist circumference(WC), oral glucose tolerance test (OGTT), insulin, insulin resistance (IR) measured by HOMA, triglycerides (TG), HDL, and systolic and diastolic blood pressure (SBP and DBP). The definition of MS in adolescents was made according to criteria of the International Diabetes Federation (IDF), 2007. RESULTS: A total of 133 patients, 67 males (50.4%) and 66 females (49.6%) with a mean age of 12.17 ± 3.27 years, were enrolled into the study. All patients were obese, with a weight greater than the 97 h percentile for age and sex. Prevalence of several cardiovascular risk factors was as follows: WC ≥ 90th percentile for age and sex, 100%; hypertension, 26.08%; hypertriglyceridemia ≥ 150 mg/dL, 15.94%; HDL <40 mg/dL, 10.86%; fasting blood glucose levels ≥ 100mg/dL, 7.97%. The overall prevalence of metabolic syndrome was 19.6%. A comparison of different anthropometric and biochemical parameters in patients with 1 or 2 MS criteria to those with 3 or more criteria showed that obesity and insulin resistance were significantly greater the greater the number of MS criteria met. CONCLUSIONS: 1.) Prevalence of MS in obese children and adolescents is high, 2). Arterial hypertension and hypertriglyceridemia are the most prevalent metabolic changes in the population studied and 3). Early intervention to control childhood obesity is essential to prevent cardiovascular morbidity and mortality in the future.

Complicated osteoporosis in progeroid syndrome: treatment with teriparatide.

Human progeroid syndromes (PSs) include a group of genetic "premature aging" diseases that affect a variety of organ systems. Bone diseases are common sequelae of patients diagnosed with PSs. Teriparatide therapy is recommended for elderly men with low bone mineral density (BMD; T-score <-2.5) and at least 1 fragility fracture who are unable to tolerate bisphosphonates. We describe a 20-yr-old patient affected by PS and severe osteoporosis complicated with femoral fracture. The patient experienced a significant improvement in lumbar spine BMD after treatment with teriparatide.

[Effect of abdominal obesity on size of myocardial infarction]. / Impacto de la obesidad central en la extensión del área de necrosis miocárdica.

OBJECTIVE: Metabolic syndrome consists of a group of factors that predict the risk of having an acute cardiovascular event. Some of these factors increase the risk of myocardial infarction and are also associated with the severity of cardiovascular events. The objective was to determine the influence of factors associated with metabolic syndrome, and especially abdominal obesity, on the size of coronary events, estimated by the concentration of total creatine phosphokinase (CPK) and CPK-MB isoenzyme (CPK-MB). SUBJECTS AND METHOD: We performed a cross-sectional study of 40 men diagnosed with acute coronary syndrome. We collected clinical data (age, history of diabetes, dyslipidemia and hypertension ) and anthropometric data [body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHR)]. CPK and CPK-MB concentrations were measured to determine the maximum concentration reached in order to estimate the size of the myocardial infarction area. RESULTS: The prevalence of metabolic syndrome was 30%. Approximately 84% of the patients were overweight and 42% had abdominal obesity. A positive association was found between myocardial enzymes and anthropometric parameters (BMI, WC, WHR). The variable showing the closest association with the size of myocardial infarction was central obesity [total CPK, r (Pearson) = 0.47; p<0.003] and (CPK-MB, r= 0.4; p<0.01). Metabolic syndrome was not a predictive factor for the size of myocardial necrosis (beta=-0.29; p<0.1). Multiple regression analysis showed that WC predicted maximal total CPK (beta=37.15; 95% CI, 9.16-65.15; p<0.01) and CPK-MB concentrations (beta=5.7; 95% CI, -0.4-11.9; p< 0.06) after an acute coronary event. CONCLUSIONS: The presence of abdominal obesity was associated with greater myocardial necrosis size after an acute coronary event.

[Primary hyperparathyroidism. An alternative to the surgery]. / Hiperparatiroidismo primario. Una alternativa a la cirugía.

Primary hyperparathyroidism is caused by an adenoma/hyperplasia in the parathyroid glands in which hypercalcemia is mainly due to an increased secretion of parathormone (PTH). The only definitive treatment is surgery. There are some patients at high surgical risk or who refuse surgery, and whose hypercalcemia cannot be controlled with conventional medical therapy such as hydration, diuretics and/or oral biphosphonates. We suggest the use of two drugs indicated for the treatment of hypercalcemia of other etiologies: zoledronic acid, a parenteral bisphosphonate, and cinacalcet, a calcimimetic agent that reduces PTH secretion. We present the case of a woman with hypercalcemia due to primary hyperparathyroidism caused by an adenoma, who was treated with both drugs.