Problemática nutricional del vegetarianismo en el embarazo, la lactancia y la edad infantil / Nutritional concerns regarding vegetarianism during pregnancy, breast-feeding and chilhood

La dieta vegetariana está siendo adoptada por un porcentaje creciente de población. En sus variedades lacto u ovolactovegetariana, el riesgo nutricional puede ser minimizado mediante una buena combinación de alimentos. Sin embargo, una dieta vegetariana estricta puede tener repercusiones negativas sobre todo en periodos de rápido crecimiento, y afectar el desarrollo físico y psicomotor. Deben controlarse de forma especial los requerimientos mínimos de ácidos grasos polinsaturados de larga cadena (PLC), hie-o, cinc y vitamina B 12 (AU)

Endoscopic injection of ethanolamine as a treatment for achalasia: a first report.

BACKGROUND AND STUDY AIMS: The present study aimed to test the hypothesis that endoscopic sclerotherapy may effectively reduce the occurrence of spasm at the level of the gastric cardia, offering an effective treatment for achalasia. PATIENTS AND METHODS: We prospectively treated 33 achalasia patients by repeated injection of ethanolamine oleate at the cardiac level. Twenty patients (series I) were reassessed after six to nine months, with a mean follow-up of 31.5 months (range 13-54 months) after treatment. In an attempt to avoid stricture formation, the last 13 patients (series II) were then treated on the basis of the need to reduce the number of injections per session and avoid new treatment while inflammatory or ulcerative signs, or both, were present. The series II patients were followed up for a mean of 11 months (range 1.7-21.3 months). RESULTS: Overall, a mean of 3.6 treatments was required, and the result was described as "excellent" or "good" in 31 of the 33 patients after one month. Two patients had a poor response to the treatment, but their condition improved after repeat treatment. After six to nine months, the subjective parameters (dysphagia, regurgitation, bronchopulmonary symptoms) and objective parameters (diameter of the esophagus, scintigraphy, manometry), had improved considerably after the treatment in the series I patients, and this improvement was sustained for more than two years, at least by subjective criteria. Four of the 20 series I patients developed mild or moderate fibrotic strictures, but these were managed successfully by standard 15-20 mm balloon dilation. No additional strictures were recorded in the last thirteen patients treated (series II). None of the patients who were followed up had to undergo surgery due to failure of the treatment. CONCLUSION: Endoscopic sclerotherapy appears to be a very promising alternative to the currently available therapeutic tools for achalasia.

Combined (short-term plus longterm) sclerotherapy v short-term only sclerotherapy: a randomised prospective trial.

Short term sclerotherapy (by injection(s) around the bleeding point) is used for immediate control of massive haemorrhage from oesophagogastric varices. The usefulness of longterm sclerotherapy once short term sclerotherapy has been successfully carried out was assessed. Two treatment groups were studied: 50 patients were treated by 'combined' (short term followed by longterm) sclerotherapy; 56 patients were treated by short term sclerotherapy only. Patients included in the second group were treated by short term sclerotherapy only if a variceal rebleeding was present. The overall cumulative proportion of patients rebleeding was not significantly different in either group. Combined sclerotherapy patients, however, experienced less episodes of variceal haemorrhage and the source of haemorrhage was different (p < 0.002). Combined sclerotherapy was more efficient in preventing bleeding from oesophageal bleeding points but not those arising from a junctional source (p < 0.05). A greater incidence of oesophageal rebleeding was found in those patients whose first source of bleeding was oesophageal (p < 0.05). No significant difference was detected in survival expectancy between either group. In conclusion, after short term sclerotherapy is carried out successfully, those patients with bleeding from variceal bleeding points located on oesophageal mucosa should benefit most from a longterm sclerotherapy programme.

Idiopathic acute esophageal necrosis: not necessarily a terminal event.

Idiopathic acute esophageal necrosis (AEN) has been considered a rare event, usually having an ischemic origin. Primarily cases from autopsy studies have been reported. This report deals with 10 such cases which were diagnosed among some 80,000 esophago-gastroscopies performed during a 16-year period. Nine patients recovered and were discharged from the hospital. The esophageal lesions presented as a demarcated, black discoloration which usually evolved to a picture suggestive of unspecific esophagitis. Histology invariably revealed diffuse and conspicuous necrosis involving the mucosa, submucosa and, frequently, muscular layers. In 2 cases, esophageal stenosis developed and, in one case, a full-thickness necrosis made surgery with colon interposition mandatory. Hyperglycemia, hypoxia, carcinoma and ischemic phenomena were found as associated conditions. Gastroduodenal, acute ulcerative disease was present in four patients. From this experience, it is concluded that AEN is not necessarily a terminal phenomenon, notwithstanding that it is usually associated with pre-existent serious illness. Nevertheless, its etiology remains unknown.

Endoscopic local injection of ethanolamine oleate and thrombin as an effective treatment for bleeding duodenal ulcer: a controlled trial.

The injection of a mixture of ethanolamine oleate and thrombin as an effective treatment for bleeding duodenal ulcer was evaluated in 38 patients entered in a randomised prospective controlled trial. After a one week observation period, 1/19 (5.3%) treated patients and 11/19 (57.9%) control patients had suffered further bleeding (p less than 0.005; CI = 22%-74%). Emergency surgery was required in 1/19 in the treated group compared with 8/19 in the untreated group (CI = 13%-61%; p less than 0.05). The mean (SD) transfusion requirement in the treated group was 1.9 (0.5) U blood compared with 5.3 (0.7) U in the control group. No significant differences related to mortality were detected. In conclusion, local injection therapy is an effective means of haemostasis in patients with bleeding duodenal ulcer who are at risk of further bleeding.

A randomized trial of tamponade or sclerotherapy as immediate treatment for bleeding esophageal varices.

Sengstaken-Blakemore tamponade is used for the initial control of bleeding esophageal varices (BEV), although it is known to be potentially dangerous. Sclerotherapy has been shown to be effective in the treatment of BEV. This trial has been designed to evaluate comparatively the effectiveness of both procedures in the initial control of the hemorrhage. Forty-three patients with BEV were included in the trial. Twenty patients (group SB) were treated by tamponade. Twenty-three patients (group ST) were treated by sclerotherapy by means of a simple technique. During the first 24 hours, hemostasis was obtained in 16 of the SB patients and in all 23 of the ST patients (p less than 0.05). At seven days, nine SB patients and 19 ST patients were free of hemorrhagic relapse (p less than 0.05). By stratifying in relation to hepatic failure, the difference was greater (p less than 0.005) if patients with Child's A classification were excluded. It is concluded that sclerotherapy should be undertaken in almost every instance at the same moment that diagnosis is made, bypassing the intermediate step of tamponade.

Vascular malformations of the stomach and duodenum: an endoscopic classification.

Having reviewed 47 cases of vascular malformations of the stomach and duodenum, we propose an endoscopic classification for these lesions: Pattern I (flat or slightly protruded, bright red lesions with frond-like margin) is the most usual form of presentation. The "telangiectatic form" (pattern II) is an endoscopic variation, with the same clinical and, possibly, pathogenic significance. Submucosal nodular forms (pattern III) are the most difficult to diagnose and treat. Electrocoagulation is the most pertinent treatment.

Retrospective endoscopic analysis of gastric xanthelasma in the non-operated stomach.

To investigate the significance of gastric xanthelasma, a retrospective review of 109 cases with an endoscopic diagnosis of this lesion was undertaken. A predominance in older patients was noted, with a similar distribution in antrum and fornix. In 15 cases (16.6%) they were multiple. They were occasionally associated with gastric erosions. In particular they were associated with chronic gastritis and intestinal metaplasia (48.9%). It is therefore concluded that gastric xanthelasma is not a rare lesion and that it is frequently associated with senile degenerative changes in the gastric mucosa.

[Changes in linoleic and arachidonic acids in the immediate neonatal period]. / Variaciones de los ácidos linoleico y araquidónico en el período neonatal inmediato.

Linoleic and arachidonic acids were studied in 18 healthy full term newborn infants during the neonatal period. A percentual decrease of arachidonic acid relative to blood umbilical cord values was observed at 24 hours of life. No changes in linoleic acid were observed. Physiologic implications are discussed.

[Differences between fatty acids of the linoleic series (n-6) and linolenic (n-3) in erythrocyte phospholipids in newborn and premature infants]. / Diferencias de los ácidos grasos de la serie linoleico (n-6) y linolénico (n-3), en los fosfolípidos de los hematíes en recién nacidos y prematuros.

Percentage of fatty acids in phospholipids of red cell membranes from cord blood of 13 full-term and 11 premature infants is studied. Percentage of 22:5n6, final metabolite of n6 series, was significantly diminished in premature infants, whereas the percentage of arachidonic acid was significantly increased in the same group. The possibility that an enzymatic abnormality be present in desaturation from 22:4n6 to 22:5n6 is speculated, as well as of its physiologic implications.

[Normal fatty acid values in lipid fractions of plasma in the pediatric period]. / Valores normales de ácidos grasos en fracciones lipídicas del plasma en la época pediátrica.

A total of 40 blood samples (8 from umbilical cord, 12 from infants aged 0-2 years, and 20 from older children) have been analyzed. Fatty acid composition of different plasma lipidic fractions were determined. The differences showed between these age groups are described. Their possible use as standards for comparison with several disorders is proposed.

[Isolated isoleucine deficiency in diet therapy of a case of maple syrup urine disease]. / Déficit aislado de isoleucina en el curso del tratamiento dietético de un caso de enfermedad de "jarabe de arce".

A case of maple syrup urine disease is described presenting during diet therapy a clinical picture with predominant cutaneous symptoms attributed to a dietary deficiency. It is believed that probable cause was the coexistence of low serum levels of isoleucine with still elevated levels of leucine. Given the metabolic interrelationship existing between different branch-chained amino acids, an independent dietary correction of each amino acid is recommended.

[Follow-up of essential fatty acids in parenteral nutrition in which a fat preparation is included]. / Seguimiento de los ácidos grasos esenciales a lo largo de la alimentación parenteral, en la que se incluye un preparado graso.

Changes in essential fatty acids of twenty two patients during parenteral nutrition are studied. Two populations (neonatal and others) were differencied. In the neonatal group a percentual decrease in arachidonic acid was showed. In both groups a percentual increase of linoleic acid was observed. Possible implications of these findings are discussed.