Correlation research demonstrates that an inflammatory diet is a risk factor for calcium oxalate renal stone formation.

BACKGROUND AND AIMS: Previous studies have demonstrated associations between the Dietary Inflammatory Index (DII®), an analytical tool which evaluates the inflammatory potential of the diet according to the pro- and anti-inflammatory properties of its components, and renal stone formation. However, these have not comprehensively addressed important parameters such as stone type, gender, DII scores in stone formers (SFs) and healthy controls (Cs) and associations of DII with urine and blood chemistries. These were adopted as the survey parameters for the present study, the purpose of which was to test whether the contributory role of an inflammatory diet on stone formation could be further confirmed. METHODS: 97 calcium oxalate (CaOx) SFs and 63 Cs, matched for age and gender each completed a semi-quantitative food frequency questionnaire from which nutrient composition was computed. These data were used to calculate the DII® score. To control the effect of energy intake, energy-adjusted DII scores were calculated per 1000 kcal consumed (E-DII™). A single blood sample and two consecutive overnight (8h) urine samples were collected from a subset (n = 59 SFs and n = 54 Cs) of the overall number of particpants (n = 160). These were analysed for renal stone risk factors. Data were analysed using regression models fit in R software. RESULTS: E-DII scores were found to fit the data better than DII, so they were used throughout. E-DII scores were significantly more positive (more pro-inflammatory) in SFs than in controls in the combined gender group (-0.34 vs. -1.73, p < 0.0001) and separately in males (-0.43 vs. -1.78, p = 0.01) and females (-0.26 vs. - 1.61, p = 0.05). In blood, a significant negative correlation was seen between E-DII and HDL cholesterol. In urine significant positive correlations were seen between E-DII and each of calcium (ρ = 0.25, p = 0.02), phosphate (ρ = 0.48, p < 0.001), magnesium (ρ = 0.33, p < 0.0001) and uric acid (ρ = 0.27, p = 0.004) concentrations. A significant negative correlation was seen between E-DII and urinary volume ρ = -0.27, p = 0.003). There was no correlation between E-DII scores and the relative supersaturations of urinary CaOx, calcium phosphate (brushite) and uric acid. CONCLUSIONS: Our findings provide hitherto unreported quantitative evidence in support of the notion that the diet of calcium oxalate renal stone patients is significantly more pro-inflammatory than that of healthy controls.

El papel del neumólogo en una unidad multidisciplinar de Esclerosis Lateral Amiotrófica. Reto, oportunidad y privilegio / The Role of the Pulmonologist in a Multidisciplinary Amyotrophic Lateral Sclerosis Unit. Challenge, Opportunity, and Privilege

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Enfermedad relacionada con IgG4 con afectación pulmonar / IgG4-Related Disease with Lung Involvement

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Fuentes de información alimentaria que utilizan las mujeres embarazadas y lactantes / Which are the sources of food information for pregnant and lactating women?

Objetivo: Conocer las fuentes de información dietética que utilizan las mujeres embarazadas y lactantes. Metodología: Investigación etnográfica cualitativa. Realización de 21 entrevistas semiestructuradas a embarazadas y lactantes asistentes a 14 sesiones de preparación del parto y 14 sesiones de posparto, 15 diarios de alimentación cumplimentados la semana siguiente a la entrevista y 3 etnografías realizadas en las provincias de Barcelona y Tarragona. Resultados: Las fuentes de información son: 1) Medios de comunicación: televisión, internet, libros y revistas (los dos últimos son los más empleados); el principal inconveniente es que las mujeres creen que hay demasiada información y no se entiende, por lo que consideran esta fuente la menos fiable. 2) Amistades y conocidos, que aconsejan según la experiencia propia; destaca el rol del «amigo-experto» en una cuarta parte de las mujeres entrevistadas. 3) Familiares, entre los que también se puede observar el doble rol de «familiar-experto»; las madres de las informantes desempeñan un papel importante a la hora de informar sobre la alimentación, aunque sus consejos son puestos en duda. 4) Expertos: la información que dan los profesionales es la más valorada por las gestantes y lactantes. Conclusiones: Las fuentes de información son diversas: medios de comunicación, amistades, familia y profesionales de la salud. La más respetada por las mujeres embarazadas y mujeres lactantes, es la ofrecida por profesionales de la salud

Objective: The aim of this study was to investigate the sources of dietary information and advice used by pregnant and lactating women and their adherence to this information. Methods: Qualitative etnographic research. 21 semi structured interviews were carried out with pregnant and breastfeeding women. They attended 14 sessions of childbirth preparation and 14 postpartum sessions, 15 feeding diaries completed the week after the interview and 3 ethnographies performed in the provinces of Barcelona and Tarragona. Results: Sources of information. 1) Media: television, internet, books, magazines were the most used. The most common complaint by the participants was the quantity of information and that they did not understand it. 2) Friends and acquaintances: advice was given according to own experience, 'the expert-friend' was significant in a quarter of the women interviewed. 3) Family: The double role of family/expert. Mothers of the participants played an important role. 4) Experts: mid-wives, gynecologists, pediatricians. Conclusions: The sources of information are diverse: media, friends, family and health professionals. The one most respected by pregnant women and lactating women, is that offered by health professionals

Stress-stones-stress-recurrent stones: a self-propagating cycle? Difficulties in solving this dichotomy.

Numerous studies have reported an association between stress and urolithiasis. Although urinary risk factors have been measured in several of these, compelling evidence of a causal relationship has not been established. A shortcoming is that alterations in single urinary parameters rather than ratios and quotients, which provide a more synergistic risk evaluation, have been measured. Recently, we speculated about a possible association between chronic stress and stone recurrence. This presents an intriguing dichotomy of whether stress causes stones or vice versa, or whether they are linked in a self-propagating stress-stones-stress-recurrence cycle. We investigated the latter hypothesis in a retrospective case-control designed study in which we calculated urinary ratios and quotients which are regarded as diagnostic indicators of stone risk. These included Ca/Cr, Ox/Cr, Mg/Cr, Cit/Cr, urate/Cr and citrate-magnesium-calcium ratios, activity product quotient for calcium oxalate (CaOx) and relative supersaturation of CaOx, brushite and uric acid. Overnight urinary data from 128 participants comprising 31 first time (FS), 33 recurrent (RS) CaOx stone formers and 64 controls were used. All subjects had been previously assessed for chronic stress dimensions, as well as for stress caused by their stone episodes per se. Conditional and unconditional logistic regression (with a Bonferroni correction for multiple tests) and simple linear regression were used to analyse various components of the data. Although RS had more stressful life events, with greater intensity of perception than FS, there were no significant differences between the groups regarding any of the urinary risk factors. No significant association between stressful life events and any of the urinary ratios or quotients was observed. A direct causal link between stress and stone recurrence was not indicated. We believe that future studies should shift their focus from traditional urinary risk factors to other stone-forming mechanisms. However, we recognize that there is an inherent problem in attempting to solve the stress-stones dichotomy as it would be impossible to disentangle alterations in risk factors which arise from lifestyle stress and those arising from stone episodes themselves.

[Diet in the lithiasic patient: A practical guide.] / La dieta en el paciente litiásico:una guía práctica.

The incidence and prevalence of lithiasic disease in developed countries has increased over the last years. Being diet one of the risk factors for urolithiasis, and having it evolved in conjunction with lifestyle over the last decades, such changes could explain the increase in lithiasis case-load. In this article, we analyze how the exercise of the urologist has been regarding the preventive role of diet in the lithiasis patient, what are the scientific evidences on the relationship of diet and lithiasis, and, on this base, what general dietetic recommendations we can give currently to our patients.

La dieta en el paciente litiásico: una guía práctica / Diet in the lithiasic patient: A practical guide

La incidencia y prevalencia de la enfermedad litiásica en los países desarrollados ha aumentado en los últimos años. Debido a que la dieta es uno de los factores de riesgo de la urolitiasis, y tanto esta como el estilo de vida han evolucionado en las últimas décadas, dichos cambios podrían explicarnos el aumento en la causística de la litiasis renal. En el presente trabajo analizamos cuál ha sido el proceder del urólogo en cuanto al papel preventivo de la dieta en el paciente litiásico, qué evidencias científicas existen en cuanto a la relación entre dieta y litiasis y, en base a ello, qué recomendaciones generales dietéticas podemos dar actualmente a nuestros pacientes

The incidence and prevalence of lithiasic disease in developed countries has increased over the last years. Being diet one of the risk factors for urolithiasis, and having it evolved in conjunction with lifestyle over the last decades, such changes could explain the increase in lithiasis case-load. In this article, we analyze how the exercise of the urologist has been regarding the preventive role of diet in the lithiasis patient, what are the scientific evidences on the relationship of diet and lithiasis, and, on this base, what general dietetic recommendations we can give currently to our patients

Chronic stress and calcium oxalate stone disease: influence on blood cortisol and urine composition.

OBJECTIVE: To evaluate the influence of chronic stress (CS) on urine composition of calcium oxalate (CaOx) stone patients and controls. METHODS: This case-control study enrolled 128 patients during a period of 20 months. The cases were CaOx stone formers with a recent stone episode. Controls were matched by sex and age. Dimensions of CS were evaluated in cases and controls by validated self-report questionnaires measuring stressful life events, perceived stress, anxiety, depression, burnout, and satisfaction with life. Blood and urine samples were collected to determine cortisol levels and urinary composition. RESULTS: More relations between CS dimensions and blood and urine parameters were observed in cases than in controls. In cases, the blood cortisol level was related positively with the number of stressful life events (P = .03), intensity of these events (P = .04), and anxiety (P = .04). In addition, urinary magnesium (P = .03) and pyrophosphate (P = .05) levels were positively related with satisfaction with life and burnout, respectively. In contrast, urinary magnesium levels were negatively related with perceived stress (P = .01), anxiety (P = .016), and depression (P = .03). In controls, the number of stressful life events and the intensity of stressful life events was related positively with magnesium (P = .06, P = .02) levels and negatively with blood cortisol levels (P = .03, P = .004). CONCLUSION: Based on the variation between cases and controls in relations between CS dimensions and biochemical parameters, we hypothesize that CS may trigger a differential biological response in CaOx stone formers and controls, which in turn may promote or protect against CaOx stone formation.

Chronic stress and calcium oxalate stone disease: is it a potential recurrence risk factor?

Chronic emotional stress is associated with increased cortisol release and metabolism disorders. However, few studies have evaluated the influence of chronic stress on calcium oxalate (CaOx) stone disease and its recurrence. A total of 128 patients were enrolled in this case-control study over a period of 20 months. All patients were CaOx stone formers with a recent stone episode (<3 months); 31 were first-time stone formers (FS) and 33 recurrent stone formers (RS). Dimensions of chronic stress were evaluated with self-reported validated questionnaires measuring stressful life events, perceived stress, anxiety, depression, burnout and satisfaction with life. An ad hoc self-reporting questionnaire was designed to evaluate stress-related specifically to stone episodes. Blood and urine samples were collected to determine cortisol levels and urinary composition. In addition, epidemiological data, socioeconomic information, diet and incidences of metabolic syndrome (MS) were reported. Overall, no significant differences were observed in the scores of cases and controls on any of the questionnaires dealing with stress. The number (p < 0.001) and the intensity (p < 0.001) of perceived stressful life events were higher in RS than in FS, but there were no differences between the two groups in other dimensions of stress. RS had higher glucose (p = 0.08), uric acid (p = 0.02), blood cortisol (p = 0.01), and urine calcium levels (p = 0.01) than FS. RS also had lower economic levels (p = 0.02) and more frequent incidences of MS (p = 0.07) than FS. Although no differences were observed in cases and controls among any dimension of chronic stress, the number and intensity of stressful life events were higher in RS than in FS. These differences correlate with variations in blood and urinary levels and with metabolic disorders, indicating an association between chronic stress and risk of recurrent CaOx stone formation.

Estudio del efecto de citocinas proinflamatorias en las células epiteliales de pacientes fumadores con o sin EPOC / A study of the Effect of Proinflammatory Cytokines on the Epithelial Cells of Smokers, with or without COPD

Introducción: El humo de tabaco es la principal causa de la inflamación en la EPOC. Los mecanismos quediferencian a los fumadores que desarrollan EPOC son diversos. En este estudio analizamos la diferentepresencia de citocinas en secreciones respiratorias de pacientes fumadores con o sin EPOC y las propiedadessecretoras del epitelio bronquial diferenciado, obtenido de los propios individuos tras su exposiciónal humo de tabaco.Material y métodos: Se estudió a 27 pacientes fumadores, 12 de ellos con EPOC no tratados previamentecon esteroides. En 11 se obtuvo la muestra mediante esputo inducido y el resto procedía del aspiradobronquial tras fibrobroncoscopia. Se determinaron las concentraciones de IL8, IL13 y TNF en el sobrenadante.Se compararon los resultados obtenidos entre individuos con o sin EPOC y se investigó su relacióncon la gravedad de la EPOC expresada según el grado de obstrucción, disnea, presencia de hipersecrecióne intensidad del tabaquismo. Se obtuvieron cultivos de células diferenciadas epiteliales bronquiales,mediante interfase aire-líquido en 4 individuos fumadores. Las muestras fueron expuestas a concentracionescrecientes de humo de tabaco (5-20%) y se determinó la expresión epitelial de ARNm de Muc5AC,IL8 y TNF .Resultados: Los pacientes con EPOC tenían valores significativamente más altos de IL8 que los fumadoressanos (41 [22] vs. 21 [12] pM). Los valores de IL8 se correlacionaron de forma significativa con la gravedadde la obstrucción (r = 0,6; p < 0,05), disnea (r = 0,45; p < 0,05) y la presencia de hipersecreción. No habíarelación entre las citocinas y la intensidad o duración del hábito tabáquico. El humo de tabaco produjoun incremento dependiente de la dosis en la expresión de ARNm para Muc5AC, IL8 y TNF. Conclusiones: Existen diferencias en la producción de citocinas, fundamentalmente IL8, entre individuosfumadores sanos o con EPOC que podrían ser justificadas por la acción directa del humo de tabaco sobrelas células epiteliales (AU)

Introduction: Cigarette smoke is the main cause of inflammation in COPD. The mechanisms that differentiatesmokers who develop COPD are diverse. In this study, we analyzed the presence of cytokines in therespiratory secretions of smokers with or without COPD and the secretory properties of the differentiatedbronchial epithelium obtained from the individuals themselves after exposure to tobacco smoke.Material and methods: Twenty-seven smokers were studied, 12 of whom had COPD that had not beenpreviously treated with steroids. In 11, samples were obtained by means of induced sputum, and the remaining samples were collected from bronchial aspiration after bronchoscopy. Concentrations of IL-8,IL-13 and TNF in the supernatant were determined. The results obtained were compared between individualswith and without COPD, and we studied their relationship with the severity of COPD as expressedby the degree of obstruction, dyspnea, presence of hypersecretion and intensity of smoking. Bronchialepithelial cell cultures were obtained by air-liquid interface in 4 smokers. The samples were exposed toincreasing concentrations of cigarette smoke (5-20%) and the epithelial mRNA expressions of MUC5AC,IL8 and TNF were determined.Results: COPDpatients had significantly higher values of IL-8 than healthy smokers (41 [22] vs. 21 [12] pM).The values of IL-8 correlated significantly with the severity of the obstruction (r = 0.6; p < 0.05), dyspnea(r = 0.45; p < 0.05) and the presence of hypersecretion. There was no relationship between cytokines andthe intensity or duration of the tobacco habit. Cigarette smoke produced a dose-dependent increase inthe expression of RNAm for Muc5AC, IL8 and TNF .Conclusions: There are differences in cytokine production (fundamentally IL8) between smokers and smokerswith COPD which could be explained by the direct action of cigarette smoke on epithelial cells (AU)

Utilidad de la resonancia magnética con espectroscopia en el diagnóstico del cáncer de próstata / Use of magnetic resonance spectroscopy in diagnosing prostate cancer

Introducción: El diagnóstico del cáncer de próstata (CaP) está basado inicialmente en una combinación del valor del antígeno prostático específico (PSA), el tacto rectal (TR) y los hallazgos de la ecografía transrectal de la próstata (ETR). La ETR ofrece la posibilidad de realizar biopsias aleatorias de la glándula prostática, que a menudo acaban siendo múltiples biopsias repetidas negativas en pacientes con elevación persistente del PSA, debido a la baja especificidad de este marcador. La resonancia magnética (RM) endorrectal es actualmente el mejor método de imagen para la detección del CaP. La espectroscopia por RM endorrectal (RMS) es una técnica no invasiva que complementa el diagnóstico del CaP mediante la detección de metabolitos intracelulares a nivel de la próstata, tales como la colina y el citrato. La RMS combinada con la RM endorrectal mejora de forma significativa la evaluación de la localización del CaP. Método: Se realizó un estudio para determinar la eficacia de la RMS en la detección precoz del CaP en pacientes con elevación del PSA, alteración del TR o ambos, candidatos a biopsia transrectal de próstata. Seleccionamos 51 pacientes entre 50-65 años con PSA entre 4-15 ng/ml con o sin alteración del TR, que debían ser sometidos a biopsia TR de próstata. La sospecha de tumor según la RM y RMS fue clasificada en una escala de 1-4, en la que 1 equivale a normal y 4 a cáncer. Comparamos 306 imágenes (6 por paciente) de RM y 306 curvas espectroscópicas con los valores de PSAt, índice de PSAt/PSAl, TR y la AP de cada uno de los sextantes. Resultados: Diagnosticamos CaP en 23 de 45 pacientes (45%) y en 78 de 306 sextantes (25%). El cociente CC/Ci fue significativamente superior en los pacientes con CaP (1.05 ± 0.41) en comparación con los pacientes en los que no se demostró CaP (0.51 ± 0.21). El índice PSAl/PSAt fue también significativamente inferior en los pacientes con CaP (11.35%) respecto de los pacientes sin CaP (16.55%)...

Utilidad de la resonancia magnética con espectroscopia en el diagnóstico del cáncer de próstata / Use of magnetic resonance spectroscopy in diagnosing prostate cancer

Introducción: El diagnóstico del cáncer de próstata (CaP) está basado inicialmente en una combinación del valor del antígeno prostático específico (PSA), el tacto rectal (TR) y los hallazgos de la ecografía transrectal de la próstata (ETR). La ETR ofrece la posibilidad de realizar biopsias aleatorias de la glándula prostática, que a menudo acaban siendo múltiples biopsias repetidas negativas en pacientes con elevación persistente del PSA, debido a la baja especificidad de este marcador. La resonancia magnética (RM) endorrectal es actualmente el mejor método de imagen para la detección del CaP. La espectroscopia por RM endorrectal (RMS) es una técnica no invasiva que complementa el diagnóstico del CaP mediante la detección de metabolitos intracelulares a nivel de la próstata, tales como la colina y el citrato. La RMS combinada con la RM endorrectal mejora de forma significativa la evaluación de la localización del CaP. Método: Se realizó un estudio para determinar la eficacia de la RMS en la detección precoz del CaP en pacientes con elevación del PSA, alteración del TR o ambos, candidatos a biopsia transrectal de próstata. Seleccionamos 51 pacientes entre 50-65 años con PSA entre 4-15 ng/ml con o sin alteración del TR, que debían ser sometidos a biopsia TR de próstata. La sospecha de tumor según la RM y RMS fue clasificada en una escala de 1-4, en la que 1 equivale a normal y 4 a cáncer. Comparamos 306 imágenes (6 por paciente) de RM y 306 curvas espectroscópicas con los valores de PSAt, índice de PSAt/PSAl, TR y la AP de cada uno de los sextantes. Resultados: Diagnosticamos CaP en 23 de 45 pacientes (45%) y en 78 de 306 sextantes (25%). El cociente CC/Ci fue significativamente superior en los pacientes con CaP (1.05 ± 0.41) en comparación con los pacientes en los que no se demostró CaP (0.51 ± 0.21). El índice PSAl/PSAt fue también significativamente inferior en los pacientes con CaP (11.35%) respecto de los pacientes sin CaP (16.55%)...(AU)

[Primary lymphoma of penis]. / Linfoma primario de pene.

We describe a case of primary penis lymphoma in a 71 yr old man. We review the bibliography and we emphasize the peculiarity and different sorts of clinical presentation. The initial symptoms were insidious. Physical examination and ultrasound findings made it indistinguishable from other tumors. A MRI confirmed the presence of a tumoral process with a homogeneous density in the distal part of the penis whose biopsy with immune histological processing confirmed us the diagnosis of primary penis lymphoma. The combined treatment with chemotherapy and radiotherapy allowed preserving the sexual organ and being without disease at 48 month of follow up.

Linfoma primario de pene / Primary lymphoma of penis

Se describe un caso de linfoma primario de pene en un paciente de 71 años. Se revisa la bibliografía destacando su extrema rareza y las diferentes formas clínicas de presentación. La clínica fue insidiosa, y los datos de la exploración física y los hallazgos ecográficos la hicieron indistinguible de otras neoplasias. La resonancia magnética confirmó la existencia de un proceso neoformativo de densidad homogénea en la parte distal del pene, cuya toma biópsica junto con las técnicas de inmunohistoquímica confirmó el diagnóstico de linfoma de pene. El tratamiento combinado de quimio y radioterapia permitió conservar el órgano, encontrándose el paciente a los 48 meses libre de enfermedad (AU)

We describe a case of primary penis lymphoma in a 71yr old man. We review the bibliography and we emphasize the peculiarity and different sorts of clinical presentation. The initial symptoms were insidious. Physical examination and ultrasound findings made it indistinguishable from other tumors. A MRI confirmed the presence of a tumoral process with a homogeneous density in the distal part of the penis whose biopsy with immune histological processing confirme us the diagnosis of primary penis lymphoma. The combined treatment with chemotherapy and radiotherapy allowed preserving the sexual organ and being without disease at 48 month of follow up (AU)

[Female urethra diverticula]. / Diverticulos de uretra femenina.

OBJECTIVES: To remind the most relevant features on the presenting clinical picture, diagnosis and treatment of this disease, which is not uncommon although many times is not suspected. METHODS: We review five cases of female urethra diverticula diagnosed in our department over the last five years. We describe the clinical picture, physical examination, diagnostic tests, as well as treatment undertaken in each, comparing them with current bibliography up to date. RESULTS: 1-Three out of five patients presented a tumor in the anterior vaginal wall; one had stress urinary incontinence and the other recurrent urinary tract infection. 2-The diagnostic methods employed were urethroscopy, retrograde and voiding urethrography, transvaginal ultrasound, and pelvic MRI. The lost two cases were diagnosed by MRI as the only diagnostic test. 3-Surgical treatment was chosen in all cases, being transvaginal diverticulectomy the chosen operation. One patient underwent transurethral diverticulectomy with the Sachse urethrotome for a post operative recurrence. CONCLUSIONS: Female urethra diverticulum is a clinical entity many times underdiagnosed that should be suspected in every patient with chronic lower urinary tract symptoms. We have several available imaging tests which can confirm the working diagnosis, either alone or in combination, being MRI the newest. Surgical treatment has demonstrated to be curative, with the transvaginal technique as the most effective and therefore the one of choice.