[Bacterial translocation: the effect of supplements with dietary fiber in enteral diets in an experimental model of methotrexate-induced enterocolitis]. / Translocación bacteriana: efecto de los suplementos con fibra dietética a dietas enterales, en un modelo experimental de enterocolitis inducida por metotrexate.

Bacterial translocation, described by 1979 by Berg and Garlington as the movement of viable bacteria through anatomically intact intestinal mucosa to the mesenteric ganglia, is suspected of playing an important role in the development of sepsis with no apparent focus, fundamentally in polytraumatized and sever surgical patients: even now, with the wide range of antibiotic and chemotherapy agents available for treatment, this sepsis represents a high rate of hospital morbid-mortality. To assess the function as barrier of the intestinal mucosa and the influence of dietary fiber thereon, we studied bacterial translocation measured as positive cultures of the mesenteric lymphatic ganglia in an experiment model of enterocolitis induced by the intraperitoneal injection of 20 mg/kg of Methotrexate (MTX), using 72 male S-D rats, half of which were used as control group. These animals were sub-divided into four series according to the diet they were to receive. In addition to bacterial translocation, we examined the intestinal mucous parameters (mucosa weight, protein and DNA content, and number of mitoses) to quantify the potential trophic effect of dietary fiber on the intestinal mucosa. In the group subject to enterocolitis, there were no significant differences in the bacterial translocation with the series fed with defined-formula diets supplemented or otherwise with dietary fiber. Only the series receiving standard feed showed a significant reduction of bacterial translocation. pectin improved all mucous parameters when compared with the other diets studied. In the control group, the bacterial translocation rate was zero in all dietary series.

[Hypocaloric peripheral parenteral nutrition]. / Nutrición parenteral periférica hipocalórica.

We carried out a prospective study of a group of 84 patients entering the Digestive Surgery Service for surgery, dividing them at random into two groups, one fed with peripheral parenteral nutrition (PPN) and the other with conventional serum therapy during the period of post-operative fasting. The aim of this study was to see whether PNN can provide significant benefits from a nutritional stand-point in comparison with the traditional serum treatment used until now. We appraised the nutritional state immediately prior to the operation, at the time of hospital admission, and compared it with that one week following the operation. We found improvements in the PNN group. The deterioration following surgery occurred in the two groups in significant form, although less in patients treated with PNN, in whom there was no variation in the nutritional state on admission and one week following surgery, while such a variation did occur in those undergoing serum therapy. PNN is a good option where the digestive pipe cannot be used as nutrient input, for a period of time which is not prolonged, but different solutions must continue to be examined which provide a greater nutritional substrate that that used by us.

[Nutritional status of patients undergoing digestive surgery]. / Estado nutricional de los pacientes de cirugía digestiva.

A retrospective study of 102 patients, analysing the incidence of malnutrition, was done in the Digestive Surgery Department of the Queen Sophia University Hospital, Cordoba. Patients were subjected to a protocol of nutritional evaluation to find out their nutritional condition and type and degree of malnutrition. The high incidence of malnutrition sufferers (> 80%) at the time of hospital admission was confirmed, being more noticeable in neoplastic patients.

Dose-ranging study to delineate the additive antihypertensive effect of guanabenz and captopril.

This open crossover study in eight hypertensive patients defined a possible additive effect of oral guanabenz and captopril and determined a safe and effective dose range. Each group of four patients received placebo followed by ascending doses (on alternate days) of either guanabenz (2, 4, 8 mg) or captopril (6.25, 12.5, 25 mg) as initial monotherapy and were subsequently crossed over to the alternate monotherapy. Guanabenz and captopril were given concomitantly in increasing doses--the highest dose for both groups being 8 mg guanabenz/25 mg captopril. When guanabenz and captopril were given concomitantly, blood pressure decreased, both from the values during placebo administration and from the lead-in values recorded before each dose. Mean supine systolic and diastolic blood pressures after combination therapy decreased significantly (P less than .05) in a dose-related manner at most evaluations. The authors conclude that guanabenz and captopril have an additive effect when administered in combination to patients with hypertension.

[Complications of TPN in gastrointestinal surgery patients]. / Complicaciones de la NPT en pacientes sometidos a cirugía gastrointestinal.

Retrospective study of a group of 77 patients subjected to gastrointestinal surgery, who received total parenteral nutrition (TPN) during the postoperative period, During the evolution of the nutrition, 76 cases with technical complications arose, one case of sepsis, 10 cases of metabolic complications and one patient with haematological complications (acute medular failure). Although a higher percentage of metabolic and haematological alterations not requiring medical or surgical treatment for correction was observed, these were indicative of the tendencies of the metabolic and haematological states of the patients. An analysis was also made of the variance, observing a direct relationship between the components of TPN and the variations of the metabolic and haematological values studied, However, these values did not correlate with the number of days during which the patients was on nutrition, and thus the technique and guidelines for administration are the most important factors which determine the presence or absence of complications during TPN.

[The use of opiates in hospital practice]. / Uso de opioides en la práctica hospitalaria.

We analyzed the type and dosage of opiates used for pain in a large general hospital from April to September 1985. Information was obtained from the computerized data base in 234 patients with a mean age of 49 years. Most patients came from the surgical service. The route of administration was intramuscular in 64% and not specified in 10% of patients. The most common drug was meperidine, the dose being 65 +/- 26 mg intramuscular and 39 +/- 26 intravenously. Methadone and morphine were used with less frequency. Good analgesic effect was recorded in 42 of 71 (59%) of patients, but the effect was not written down in the majority of subjects (70%). Other analgesics were associated in 73% of cases, most commonly a pyrazolone derivative. Nausea or vomiting was observed in only 12 patients; there were no instances of respiratory depression. We conclude that the dose of opiate used was frequently low and the associated drugs were not the best to obtain increased analgesic effect. Better recording of clinical effect of analgesics is needed in medical practice.

Effects of the non-steroidal anti-inflammatory drugs, piroxicam or sulindac, on the antihypertensive actions of propranolol and verapamil.

Twenty-five hypertensive patients participated in a randomized placebo-controlled study. After blood pressures were normalized with propranolol or verapamil alone over a 6-week period, patients were entered into a 4-week double-blind period where they received non-steroidal anti-inflammatory drug (NSAID) treatment (sulindac or piroxicam) or placebo treatment in addition to their antihypertensive therapy. There was a significant elevation in standing systolic blood pressure (P less than 0.05) with propranolol and sulindac, when compared with propranolol and placebo, but no significant changes were shown with propranolol and piroxicam. Systolic blood pressures on sulindac treatment were significantly lower (P less than 0.05) in both supine and standing positions during treatment of hypertension with verapamil compared with propranolol. Both supine systolic and diastolic blood pressures on piroxicam treatment were significantly lower (P less than 0.05) during treatment of hypertension with verapamil compared with propranolol. We conclude that NSAID transiently block the antihypertensive effect of propranolol, causing blood pressures to increase and side effects to improve. However, NSAID do not cause loss of antihypertensive control with verapamil.

Antihypertensive effect of doxazosin in hypertensive patients: comparison with atenolol.

The antihypertensive effect of doxazosin 1-16 mg once-daily was compared with that of atenolol 50-100 mg once-daily, and placebo, utilizing a double-blind parallel group (12 patients each) design. Blood pressure (BP) and pulse rate were determined in out-patients who returned for clinic visits every 2 weeks for 14 weeks. During the first 4 weeks, all patients received single-blind placebo therapy. During the subsequent 10 weeks, patients were randomized to placebo, atenolol or doxazosin treatment. After 2 weeks of doxazosin therapy 16 mg daily, there was a significant decrease from baseline (single-blind placebo period) in supine diastolic BP (P less than 0.01) and standing diastolic BP (P less than 0.001). The decreases in supine and standing diastolic BPs in the doxazosin 16 mg daily group were significantly (P less than 0.01) different from the corresponding BPs of the placebo group. At weeks 12 and 14, heart rates in the doxazosin group were not significantly different from baseline or from those in the placebo group. After 4 and 6 weeks of atenolol 100 mg daily, there was a significant decrease from baseline in both supine (P less than 0.001 and P less than 0.05) and standing (P less than 0.05) diastolic BPs and heart rates (P less than 0.05). However, when the atenolol group was compared with the placebo group, a significant decrease occurred only with supine diastolic BP at week 12 (P less than 0.01) and not at week 14; but significant decreases occurred in supine and standing heart rates at weeks 12 and 14 (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)