Effect of inulin and fructo-oligosaccharide on the prevention of acute radiation enteritis in patients with gynecological cancer and impact on quality-of-life: a randomized, double-blind, placebo-controlled trial.

BACKGROUND/OBJECTIVES: The pathogenesis of enteritis after abdominal radiotherapy (RT) is unknown, although changes in fecal microbiota may be involved. Prebiotics stimulate the proliferation of Lactobacillus spp and Bifidobacterium spp, and this may have positive effects on the intestinal mucosa during abdominal RT. SUBJECTS/METHODS: We performed a randomized, double-blind, placebo-controlled trial involving patients with gynecological cancer who received abdominal RT after surgery. Patients were randomized to receive prebiotics or placebo. The prebiotic group received a mixture of fiber (50 inulin and 50% fructo-oligosaccharide), and the placebo group received 6 g of maltodextrin twice daily from 1 week before to 3 weeks after RT. The number of bowel movements and stool consistency was recorded daily. Diarrhea was evaluated according to the Common Toxicity Criteria of the National Cancer Institute. Stool consistency was assessed using the 7-point Bristol scale. Patients' quality-of-life was evaluated at baseline and at completion of RT using the EORTC-QLQ-C30 (European Organization for Research and Treatment of Cancer quality-of-life Questionnaire C30) test. RESULTS: Thirty-eight women with a mean age of 60.3±11.8 years participated in the study. Both groups (prebiotic (n=20) and placebo (n=18)) were comparable in their baseline characteristics. The number of bowel movements per month increased in both groups during RT. The number of bowel movements per day increased in both groups. The number of days with watery stool (Bristol score 7) was lower in the prebiotic group (3.3±4.4 to 2.2±1.6) than in the placebo group (P=0.08). With respect to quality-of-life, the symptoms with the highest score in the placebo group were insomnia at baseline and diarrhea toward the end of the treatment. In the prebiotic group, insomnia was the symptom with the highest score at both assessments, although the differences were not statistically significant. CONCLUSIONS: Prebiotics can improve the consistency of stools in gynecologic cancer patients on RT. This finding could have important implications in the quality-of-life of these patients during treatment.

Effect of a mixture of inulin and fructo-oligosaccharide on lactobacillus and bifidobacterium intestinal microbiota of patients receiving radiotherapy; a randomised, double-blind, placebo-controlled trial / Efecto de una mezcla de inulina y fructo-oligosacárido sobre la microflora intestinal de lactobacillus y bifidobacterium de pacientes que reciben radioterapia; un ensayo aleatorio, a doble ciego y controlado con placebo

Background & aims: The pathogenesis of enteritis after abdominal radiotherapy is unknown, although changes in faecal microbiota may be involved. In several studies, Lactobacillus and Bifidobacterium have proven beneficial for the host. Prebiotics stimulate the proliferation of Lactobacillus and Bifidobacterium, and this may have positive effects on the intestinal mucosa during abdominal radiotherapy. Methods: We performed a randomised double-blind, placebo-controlled trial including 31 patients with gynaecological cancer who received radiotherapy (29 sessions, 52.2 Gy) after surgery. Patients were randomised to two groups: prebiotic and placebo. The first group received a mixture of fibre (50% inulin and 50% fructo-oligosaccharide) and the second received 6 g of maltodextrin twice daily from one week before to three weeks after radiotherapy. Lactobacillus and Bifidobacterium counts were determined in faeces samples (day -7 before radiotherapy, day 15 of radiotherapy, at the end of treatment, and three weeks after radiotherapy) by culture in selective media and fluorescent in situ hybridization (FISH) using genus-specific probes. Bacterial counts by FISH were significantly higher than by culture method. Results: There were no differences in baseline microbiota between groups. At the end of radiotherapy, we observed a statistically significant decrease in Lactobacillus and Bifidobacterium counts in both groups. By cultural analysis, we observed higher numbers of Lactobacillus and Bifidobacterium three weeks after radiotherapy in the prebiotic group (5.6 vs. 6.3, p = 0.04 and 5.5 vs. 6 log cfu/g, p = 0.03). Conclusions: Abdominal radiotherapy negatively affects Lactobacillus and Bifidobacterium counts. The prebiotic mixture of inulin and fructoligosaccharide can improve the recovery of both genera after radiotherapy (AU)

Antecedentes y objetivos: Se desconoce la patogenia de la enteritis tras la radioterapia abdominal, si bien podrían estar implicados cambios en la microflora fecal. Diversos estudios han demostrado que los Lactobacillus y Bifidobacterium confieren beneficios al huésped. Los prebióticos estimulan la proliferación de Lactobacillus y Bifidobacterium y esto podría tener efectos positivos sobre la mucosa intestinal durante la radioterapia abdominal. Métodos: Realizamos un estudio de distribución aleatoria, a doble ciego y controlado con placebo que incluyó a 31 pacientes con cáncer ginecológico que recibieron radioterapia (29 sesiones, 52,2 Gy) tras la cirugía. Se distribuyó al azar a las pacientes en dos grupos: prebiótico y placebo. El primer grupo recibió una mezcla de fibra (50% de inulina y 50% de fructo-oligosacárido) y el segundo 6 g de maltodextrina dos veces al día desde una semana antes hasta 3 semanas después de la radioterapia. Se determinaron los recuentos de Lactobacillus y Bifidobacterium en muestras fecales (día 7 antes de la radioterapia, día 15 de radioterapia, al final del tratamiento y tres semanas después de la radioterapia) mediante un cultivo en medios seleccionados y con hibridación in situ fluorescente (FISH) con sondas específicas de la especie. Los recuentos bacterianos con FISH fueron significativamente superiores que por el método de cultivo. Resultados: No hubo diferencias en la microflora basal entre los grupos. Al final de la radioterapia, observamos un descenso estadísticamente significativo en los recuentos de Lactobacillus y Bifidobacterium en ambos grupos. Mediante el análisis de los cultivos, observamos un mayor recuento de Lactobacillus y Bifidobacterium a las tres semanas de finalizar la radioterapia en el grupo con prebiótico (5,6 frente a 6,3, p = 0,04 and 5,5 frente a 6 log ufc/g, p = 0,03). Conclusiones: La radioterapia abdominal afecta de forma negativa los recuentos de Lactobacillus y Bifidobacterium. La mezcla de prebióticos de inulina y fructo-oligo-sacárido puede mejorar la recuperación de ambas especies tras la radioterapia (AU)

Effect of a mixture of inulin and fructo-oligosaccharide on Lactobacillus and Bifidobacterium intestinal microbiota of patients receiving radiotherapy: a randomised, double-blind, placebo-controlled trial.

BACKGROUND & AIMS: The pathogenesis of enteritis after abdominal radiotherapy is unknown, although changes in faecal microbiota may be involved. In several studies, Lactobacillus and Bifidobacterium have proven beneficial for the host. Prebiotics stimulate the proliferation of Lactobacillus and Bifidobacterium, and this may have positive effects on the intestinal mucosa during abdominal radiotherapy. METHODS: We performed a randomised double-blind, placebo-controlled trial including 31 patients with gynaecological cancer who received radiotherapy (29 sessions, 52.2 Gy) after surgery. Patients were randomised to two groups: prebiotic and placebo. The first group received a mixture of fibre (50% inulin and 50% fructo-oligosaccharide) and the second received 6 g of maltodextrin twice daily from one week before to three weeks after radiotherapy. Lactobacillus and Bifidobacterium counts were determined in faeces samples (day -7 before radiotherapy, day 15 of radiotherapy, at the end of treatment, and three weeks after radiotherapy) by culture in selective media and fluorescent in situ hybridization (FISH) using genus-specific probes. Bacterial counts by FISH were significantly higher than by culture method. RESULTS: There were no differences in baseline microbiota between groups. At the end of radiotherapy, we observed a statistically significant decrease in Lactobacillus and Bifidobacterium counts in both groups. By cultural analysis, we observed higher numbers of Lactobacillus and Bifidobacterium three weeks after radiotherapy in the prebiotic group (5.6 vs. 6.3, p = 0.04 and 5.5 vs. 6 log cfu/g, p = 0.03). CONCLUSIONS: Abdominal radiotherapy negatively affects Lactobacillus and Bifidobacterium counts. The prebiotic mixture of inulin and fructoligosaccharide can improve the recovery of both genera after radiotherapy. Registered under ClinicalTrials.gov Identifier no. NCT01549782.

[Sea-blue histiocyte syndrome associated with home parenteral nutrition]. / Síndrome del histiocito azul marino en relación a nutrición parenteral domiciliaria.

A case of a 55 years-old male with long-term Crohn's disease without response to medical treatment and many intestinal fistula is presented. After the last bowel resection, home parenteral nutrition was started. He presented chronic hepatopathy and pancytopaenia. After 9 months of home parenteral nutrition hepatic function and pancytopaenia began to deteriorate. Bone marrow examination revealed an infiltrate of sea-blue histiocytes. He made unsatisfactory progress and died due to a multiorganic failure.

Síndrome del histiocito azul marino en relación a nutrición parenteral domiciliaria / Sea-blue histiocyte syndrome associated with home parenteral nutrition

Presentamos un caso de un varón de 55 años con Enfermedad de Crohn de larga evolución con mala respuesta al tratamiento médico y múltiples fístulas al que se le inició nutrición parenteral domiciliaria (NPD) tras su última resección intestinal. Presentaba hepatopatía crónica no filiada y pancitopenia leve. Tras 9 meses de soporte nutricional parenteral se produce un empeoramiento de la función hepática y la pancitopenia. Se realizó biopsia de médula ósea que mostró histiocitos azul marino. La evolución fue tórpida falleciendo a consecuencia de un fallo multiorgánico (AU)

A case of a 55 years-old male with long-term Crohn's disease without response to medical treatment and many intestinal fistula is presented. After the last bowel resection, home parenteral nutrition was started. He presented chronic hepatopathy and pancytopaenia. After 9 months of home parenteral nutrition hepatic function and pancytopaenia began to deteriorate. Bone marrow examination revealed an infiltrate of sea-blue histiocytes. He made insatisfactory progress and died due to a multiorganic failure (AU)

Long-term prevalence of oropharyngeal dysphagia in head and neck cancer patients: Impact on quality of life.

BACKGROUND & AIMS: To determine the prevalence of dysphagia in head and neck cancer patients treated with surgery and radiotherapy or chemoradiotherapy. To study the impact of dysphagia on food habits, nutritional status, and quality of life. METHODS: Retrospective cross-sectional study of 87 head and neck cancer patients treated with surgery and radiotherapy or chemoradiotherapy from January 2000 through May 2005. Time since surgery was 28.5+/-17.8 months. A clinical test was used to detect dysphagia. A nutritional assessment was performed in all patients. A questionnaire was used to evaluate quality of life. RESULTS: Oropharyngeal dysphagia was present in 50.6% of patients, mostly to solid foods (72.4%). Patients with total glossectomy and chemoradiotherapy had the highest rate of dysphagia. Nutritional support was necessary in 57.1% of patients. Malnutrition was present in 20.3% of patients, mainly marasmus (81%). Fifty-one percent of patients reported a decrease in their quality of life due to dysphagia. CONCLUSIONS: We found a high prevalence of dysphagia in head and neck cancer patients treated with surgery and coadjuvant treatment. This problem negatively affects their quality of life. It is important that nutritional surveillance be provided to detect it and to prevent malnutrition.

Presentación del nuevo registro español de pacientes con nutrición artificial domiciliaria / Presentation of the new spanish home artificial nutrition registry

Los registros son bases de datos que proporcionan información sobre una actuación o patología concreta en una población determinada. En el caso de la nutrición artificial domiciliaria (NAD) existen registros de pacientes en diferentes países europeos, EE.UU. y Japón con datos de prevalencia, indicaciones, seguimiento y complicaciones de estos tratamientos. En 1992 se creó en España el grupo NADYA, formado por profesionales con dedicación a la nutrición artificial. Una de sus inquietudes fue la creación de un registro de pacientes con NAD. Se trata de un registro voluntario al que se accede a través de la página web www.nadya-senpe. com. En el año 2005, se introdujeron algunas modificaciones para adaptarlo a la Ley de Protección de Datos. Gracias al trabajo de todos los miembros del grupo NADYA disponemos de muchos datos sobre la NAD en nuestro país. A partir de 1994, con excepción del período 97-98, se han publicado periódicamente registros anuales de nutrición parenteral domiciliaria (NPD) y nutrición enteral domiciliaria (NED), observándose un incremento en el número de pacientes y de centros colaboradores, que nos acercan a la práctica real de la NAD en nuestro país

The registries are databases including information about a treatment or a disease in a definite population. Concerning home artificial nutrition there are registries of patients in different European countries, USA and Japan, collecting data such as the prevalence, indication, follow-up and complications of these treatments. The Spanish group of Home Artificial Nutrition (HAN), NADYA, was established in 1992 with professionals devoted to the practise of artificial nutrition. Since then, one of its wills was the development of the Spanish registry of HAN. This is a voluntary registry accessible through the web page www.nadya-senpe.com. In 2005, this group decided to update the registry according to the Data Protection Law and including other improvements. Thank to the work of all the members of this group we have many data on the practise of HAN in our country. Since 1994, except the years 97-98, the annual registries of patients on home parenteral nutrition and home enteral nutrition have been published periodically, observing an increase in both, the number of patients and collaborating centres, presenting to us the actual practise of HAN in our country

[Presentation of the new Spanish home artificial nutrition registry]. / Presentación del nuevo registro español de pacientes con nutrición artificial domiciliaria.

The registries are databases including information about a treatment or a disease in a definite population. Concerning home artificial nutrition there are registries of patients in different European countries, USA and Japan, collecting data such as the prevalence, indication, follow-up and complications of these treatments. The Spanish group of Home Artificial Nutrition (HAN), NADYA, was established in 1992 with professionals devoted to the practise of artificial nutrition. Since then, one of its wills was the development of the Spanish registry of HAN. This is a voluntary registry accessible through the web page www.nadya-senpe.com. In 2005, this group decided to update the registry according to the Data Protection Law and including other improvements. Thank to the work of all the members of this group we have many data on the practise of HAN in our country. Since 1994, except the years 97-98, the annual registries of patients on home parenteral nutrition and home enteral nutrition have been published periodically, observing an increase in both, the number of patients and collaborating centres, presenting to us the actual practise of HAN in our country.

[Spanish registry of Home-Based Parenteral Nutrition for the years 2004 and 2005 (NADYA-SENPE Group)]. / Registro de la nutrici6n parenteral domiciliaria en España de los años 2004 y 2005 (Grupo NADYA-SENPE).

OBJECTIVE: To report the results of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group of the years 2004 and 2005. MATERIAL AND METHODS: We summarized the data of the new on-line HPN registry of the NADYA-SENPE group for the period 2004-2005. RESULTS: During the year 2004, 70 HPN-patients (23 males and 47 females) were registered from 14 hospitals. Mean age of adults was 53,7 +/- 14,87 years (m +/- SD) and 6 +/- 2,83 years for those younger than 14 years. The most frequent etiologies of the intestinal failure were neoplasia (24%) and mesenteric ischaemia (19%). Tunnelled catheters were used in 75% of the patients. The catheter-related infections were the most frequent complications, with a rate of 0,98 episodes/10(3) days. In 69% of the cases the nutritional support was maintained for more than 2 years. HPN solutions and disposables were supplied by the hospital pharmacy in 81% and 83%, respectively. Up to 54% of the patients had a normal activity level. The most frequent reasons to end HPN treatment were the transition to oral intake (41%), or exitus (28%). During the year 2005, 79 patients (33 males and 46 females) were registered from 14 hospitals. Mean age of adults was 52,39 +/- 14,21 years and 6,5 +/- 5,21 years for those younger than 14 yrs. The most frequent etiologies of the intestinal failure were neoplasia (22%), and mesenteric ischaemia (15%). Tunnelled catheters were used in 63% of the patients. The catheter-related infections were the most frequent complications, with a rate of 1,14 episodes/10(3) days. In 51% of the cases the nutritional support was maintained for more than 2 years. HPN solutions and disposables were supplied by the hospital pharmacy in 76% and 81%, respectively. Up to 50% of the patients had a normal activity level. The most frequent reasons to end HPN treatment were the transition to oral/enteral feeding (41%) and exitus (31%). CONCLUSIONS: We have observed a mild decrease in the number of HPN patients registered in the period 2004-2005, probably related to the change of the registry. The characteristics of the patients are similar to previous years. We have observed an increase in the septic catheter-related complications in the year 2005.

[Gastric surgery as a nutritional risk factor]. / Cirugía gástrica como factor de riesgo nutricional.

BACKGROUND: The stomach has a role in the digestion and absorption of nutrients, so patients are in nutritional risk after gastric resection. The aim of this work was to study the nutritional status of postgastrectomy outpatients followed in our hospital. METHODS: We retrospectively studied 54 patients (27 M, 27 F) followed more than 12 months postgastrectomy. Mean age was 61 +/- 14 yr and median follow-up was 35 months. The nutritional assessment included anthropometry, biochemical data and measurement of bone mineral density by dual-energy X-ray absorptiometry. The statistical analysis was performed by non-parametric tests. RESULTS: Malignancy was the most frequent indication (85%), 63% of patients had total gastrectomy. Patients were supplemented with iron (43%), B12 (87%), calcium (18%) and vitamin D (17%). 13% of patients had a BMI < 18.5. The incidence of 25 OH vitamin D deficiency and secondary hyperparathyroidism was 45% and 76%, respectively. The incidence of osteoporosis at lumbar spine was 46%. Matched with same age-sex people patients had 85.6% of bone mineral density. CONCLUSIONS: The loss of weight and the metabolic bone disease were the most prevalent impairments after gastric resection. These impairments point to the importance of a nutritional surveillance of patients after gastric resection.

Registro de la nutrición parenteral domiciliaria en España de los años 2004 y 2005 (Grupo NADYA-SENPE) / Spanish Registry of home-based parenteral nutrition for the years 2004 and 2005 (NADYA-SENPE GROUP)

Objetivo: Comunicar los resultados obtenidos en el registro de Nutrición Parenteral Domiciliaria (NPD) del grupo NADYA-SENPE en los años 2004-2005. Material y métodos: Recopilación de los datos del nuevo registro "on-line" de NPD del grupo NADYA-SENPE en el período 2004-2005. Resultados: Durante el año 2004 se registraron 70 pacientes con NPD (23 hombres y 47 mujeres) pertenecientes a 14 centros hospitalarios. La edad media de los pacientes mayores de 14 años fue de 53,7 ± 14,87 años (m ± DS) y de 6 ± 2,83 años para los menores de 14 años. La enfermedad de base más frecuente fue la neoplasia (24%) seguida de la isquemia mesentérica (19%). Los catéteres más utilizados fueron los tunelizados (75%). Las complicaciones más frecuentes fueron las sépticas relacionadas con el catéter, con una tasa de 0,98 infecciones/ 103 días. El tiempo de soporte nutricional fue superior a dos años en el 69% de los casos. El suministro de las soluciones de NPD y del material fungible fue proporcionado por las farmacias hospitalarias en el 81% y el 83%, respectivamente. El 54% de los pacientes presentaban un nivel de actividad normal. En la mayoría de los pacientes la causa de finalización de la NPD fue la transición a la dieta oral (41%), o el fallecimiento (28%). Durante el año 2005 se registraron 79 pacientes con NPD (33 hombres y 46 mujeres), pertenecientes a 14 centros hospitalarios. La edad media de los mayores de 14 años fue de 52,39 ± 14,21 años y de 6,5 ± 5,21 años para los menores de 14 años. La enfermedad de base más frecuente fue la neoplasia (22%), seguida de la isquemia mesénterica (15%). El 63% de los pacientes utilizaron catéteres tunelizados. Las complicaciones más frecuentes fueron las sépticas relacionadas con el catéter (1,14 infecciones/ 103 días). El tiempo de soporte nutricional fue mayor a dos años en un 51% de los pacientes. El suministro de las soluciones de NPD y del fungible fue en el hospital en el 76% y 81%, respectivamente. El nivel de actividad de los pacientes con NPD fue normal en el 50%. Los motivos más frecuentes de finalización del tratamiento fueron la transición a dieta oral/ enteral (41%) y el fallecimiento (31%). Conclusiones: Hemos observado un ligero descenso en el número de pacientes registrados con NPD durante el período 2004-2005, posiblemente en relación con el cambio del registro. Las características generales de los pacientes son similares a las de años anteriores. Se aprecia un aumento en la tasa de complicaciones sépticas relacionadas con el catéter en el año 2005 (AU)

Objective: To report the results of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group of the years 2004 and 2005. Material y methods: We summarized the data of the new on-line HPN registry of the NADYA-SENPE group for the period 2004-2005. Results: During the year 2004, 70 HPN-patients (23 males and 47 females) were registered from 14 hospitals. Mean age of adults was 53,7 ± 14,87 years (m ± SD) and 6 ± 2,83 years for those younger than 14 years. The most frequent etiologies of the intestinal failure were neoplasia (24%) and mesenteric ischaemia (19%). Tunneled catheters were used in 75% of the patients. The catheter related infections were the most frequent complications, with a rate of 0,98 episodes/103 days. In 69% of the cases the nutritional support was maintained for more than 2 years. HPN solutions and disposables were supplied by the hospital pharmacy in 81% and 83%, respectively. Up to 54% of the patients had a normal activity level. The most frequent reasons to end HPN treatment were the transition to oral intake (41%), or exitus (28%). During the year 2005, 79 patients (33 males and 46 females) were registered from 14 hospitals. Mean age of adults was 52,39 ± 14,21 years and 6,5 ± 5,21 years for those younger than 14 yrs. The most frequent etiologies of the intestinal failure were neoplasia (22%), and mesenteric ischaemia (15%). Tunneled catheters were used in 63% of the patients. The catheter-related infections were the most frequent complications, with a rate of 1,14 episodes/103 days. In 51% of the cases the nutritional support was maintained for more than 2 years. HPN solutions and disposables were supplied by the hospital pharmacy in 76% and 81%, respectively. Up to 50% of the patients had a normal activity level. The most frequent reasons to end HPN treatment were the transition to oral/enteral feeding (41%) and exitus (31%). Conclusions: We have observed a mild decrease in the number of HPN patients registered in the period 2004-2005, probably related to the change of the registry. The characteristics of the patients are similar to previous years. We have observed an increase in the septic catheter related complications in the year 2005 (AU)

Cirugía gástrica como factor de riesgo nutricional / Gastric surgery as a nutritional risk factor

Objetivo: El estómago tiene un papel importante en la digestión y absorción de nutrientes, por lo que los pacientes con resección gástrica están en riesgo nutricional. El objetivo del estudio fue evaluar el estado nutricional de pacientes gastrectomizados seguidos en una consulta externa de Nutrición de un Hospital General Universitario. Material y métodos: Estudiamos de manera retrospectiva 54 pacientes (27 V, 27 M) con un tiempo mínimo de evolución desde la gastrectomía de 12 meses. La edad media fue 61 ± 14 años y la media de seguimiento 35 meses. La valoración nutricional incluyó antropometría, datos bioquímicos y valoración de la densidad mineral ósea mediante DEXA. El estudio estadístico se realizó con pruebas no paramétricas. Resultados: La indicación principal de la cirugía fue oncológica (85%). El 63% de los pacientes presentaban gastrectomía total. Los pacientes recibieron suplementos de hierro (43%), vitamina B12 (87%), calcio (18%) y vitamina D (17%). El 13% de los pacientes tenían bajo peso (IMC < 18,5). La incidencia de deficiencia de 25 OH vitamina D y de hiperparatiroidismo secundario fue de 45% y 76%, respectivamente. La incidencia de osteoporosis en columna fue del 46%. Comparadas con personas de su misma edad y sexo, los pacientes mantenían el 85,6% de la densidad mineral ósea. Conclusiones: La pérdida de peso y la enfermedad metabólica ósea fueron las complicaciones más prevalentes en nuestros pacientes gastrectomizados. Por ello, creemos que es importante realizar un seguimiento nutricional en los pacientes gastrectomizados

Background: The stomach has a role in the digestion and absorption of nutrients, so patients are in nutritional risk after gastric resection. The aim of this work was to study the nutritional status of postgastrectomy outpatients followed in our hospital. Methods: We retrospectively studied 54 patients (27 M, 27 F) followed more than 12 months postgastrectomy. Mean age was 61 ± 14 yr and median follow-up was 35 months. The nutritional assessment included anthropometry, biochemical data and measurement of bone mineral density by dual-energy X-ray absorptiometry. The statistical analysis was performed by non-parametric tests. Results: Malignancy was the most frequent indication (85%), 63% of patients had total gastrectomy. Patients were supplemented with iron (43%), B12 (87%), calcium (18%) and vitamin D (17%). 13% of patients had a BMI < 18.5. The incidence of 25 OH vitamin D deficiency and secondary hyperparathyroidism was 45% and 76%, respectively. The incidence of osteoporosis at lumbar spine was 46%. Matched with same age-sex people patients had 85.6% of bone mineral density. Conclusions: The loss of weight and the metabolic bone disease were the most prevalent impairments after gastric resection. These impairments point to the importance of a nutritional surveillance of patients after gastric resection

[Treatment of inguinal hernia. Case reports]. / Trattamento dell'ernia inguinale. Contributo casistico.

BACKGROUND: The aim of this study was to evaluate the extent to which inguinal hernia surgery has changed over the past few years. As confirmed by the bibliography, the authors draw attention to the fact that the use of more resistant and well tolerated heterologous graft materials has led to the rapid spread of "tension-free" techniques which have now replaced conventional methods with good long-term results. The development of these techniques has been flanked by the growing use of day hospitals, leading to a marked reduction in hospitalization costs. METHODS: The authors describe the series of hernia operations performed by a day hospital linked to a general surgery ward over the past six years. The series refers to the 1st division of general surgery at Ospedale Nuovo Martini in Turin and covers the period from January 1993 to July 1998 with a total of 1387 patients. RESULTS: Over this short period, the percentage of inguinal hernia operations in inpatients fell from 92.9 to 22.4% while those undergoing surgery in the day hospital rose from 7.1 to 77.6%. This was flanked by a move away from conventional plastic surgery (Bassini, Shouldice) in favour of Lichtenstein's technique which was used in over 76% of monolateral hernia and over 55% of bilateral cases. Local anesthesia induced by the surgeon was used in the majority of cases (98%). Mersilene prostheses were initially used but were soon replaced by prolene grafts, both of which were well tolerated in over 84% of cases. Short-term antibiotic prophylaxis was administered in all cases, whereas the use of postoperative painkillers was limited to minor analgesics. CONCLUSIONS: The surgical treatment of inguinal hernia has changed drastically over a relatively short period with regard to both operating techniques, as is shown by the widespread use of prostheses, and the indications for day hospital surgery which have gradually increased owing to the reliability and tolerability of hernia mesh and the use of local anesthesia.

[Retroperitoneal leiomyosarcoma originating from the inferior vena cava. A case report]. / Leiomiosarcoma retroperitoneale a partenza dalla vena cava inferiore. Caso clinico.

After a brief review of the literature, the authors report a rare case primitive retroperitoneal leiomyosarcoma originating from the inferior vena cava. The tumor was diagnosed very early thanks to its early symptoms and signs (abdominal pain and palpability), which appeared when the tumor size was only 5 cm. Therefore it was possible a macroscopically radical surgical exeresis even if the anatomical situation was particularly delicate. The low grading and staging of the tumor allowed to express a positive prognosis in spite of the malignant nature of this sarcoma.

[Laparoscopic cholecystectomy. Personal experience]. / Colecistectomia laparoscopica. La nostra esperienza.

The authors present their experience (136 cases) in the treatment of cholelithiasis with coelioscopic cholecystecomy. After a comparison of this modern technique with the traditional laparotomic approach, they underline the several advantages of coelioscopy (short hospitalization and early return to patient's work, reduced post-operative abdominal pain, avoidance of laparocele, better aesthetic results). Then the authors describe the present treatment of combined cholecysto-choledochic lithiasis with the help fo ERCP (their hope is for further improvement in surgical instruments to allow a single laparoscopic solutions.

[Gastric leiomyosarcoma. Three clinical cases in emergency]. / Leiomiosarcoma gastrico. Osservazione di tre casi clinici in urgenza.

The authors describe three cases of gastric leiomyosarcoma that required surgical treatment in emergency. Myogenic gastric tumors are extremely rare (1-3% of primitive gastric neoplasias) and little is known about their biological evolution, even if they seem to have scarce power of spreading and of local invasion. Echoendoscopy appears to be the best screening method for the evaluation of staging and DT (doubling time). In the authors' opinion, when neoplasms have a diameter less than 5 cm, subtotal or total gastrectomies don't offer better results in the follow-up than simple minimal excision of the gastric tumor.

[Splenectomy versus splenic salvage. Our experience]. / Splenectomia versus conservazione di milza. Nostra esperienza.

The authors describe their experience in the surgical treatment of splenic lesions, mostly traumatic. In recent years a resolutely conservative attitude has been turned to splenic salvage, thanks to late findings on its immunological and haematological functions. Against 59 splenectomies for III-V degree lesions, the authors report a case of splenic trauma (II degree) without surgical treatment, monitored with clinical, haematological and instrumental (echography) test.

[Intestinal occlusion caused by internal hernia of the retrocaecal recess. Description of a case]. / Occlusione intestinale da ernia interna del recesso retrocecale. Descrizione di un caso.

The authors describe an acute intestinal occlusion due to a rare case of strangulated intra-abdominal hernia of the retrocaecal peritoneal recess. They underline the rarity of this pathology which is often treated in emergency without any possibility of preoperative diagnosis. Therefore, in order to carry out surgical therapy with good results, a correct knowledge of the anatomical features of these hernias is necessary.

Phenotypical characterization of lymphocyte recirculating subsets in patients undergoing splenectomy for trauma.

The spleen is a peripheral lymphatic organ where lymphocytes stop for long time during their circulation. We studied the peripheral blood lymphocyte subsets both in 30 subjects splenectomized for trauma and in 30 healthy, non splenectomized, subjects. The phenotypical characterization of lymphocyte subpopulations was performed employing monoclonal antibodies by direct immunofluorescence assays with single and double labelling. Comparing the results, we put in evidence, in splenectomized patients, an increase in all the lymphocyte subsets but one (L. G.L. Leu7+). The CD8+ population showed the major increase according with its large representation in the splenic tissue. Splenectomy induces a change in lymphocyte recirculating pool because of the loss of an important anatomical site of migration. This reduction of lymphocyte recirculating capacity can be related to a decreased efficiency in immunocompetence. In fact, many Authors showed that splenectomy is associated with several anomalies of both humoral and cellular immune response. In contrast with this, our group of splenectomized patients doesn't reveal a greater incidence of infections. We conclude that splenectomy realizes a new anatomical situation where the reduction of lymphocyte recirculating capacity can be related to a decreased statistical efficiency in immunocompetence.