Nutrición basada en la evidencia en las fístulas digestivas el intestino corto / Evidence-based nutrition in gastrointestinal fistulae and short bowel syndrome

Las fístulas digestivas y el intestino corto son 2 procesos en los que el tratamiento nutricional es de gran importancia. Existen guías de actuación clínica basadas en la evidencia que ofrecen recomendaciones generales acerca del soporte nutricional en ambos casos. En este trabajo se han revisado los metaanálisis y los estudios prospectivos aleatorizados (EPA) publicados entre 1990 y 2004 acerca del soporte nutricional en las fístulas digestivas y en el intestino corto. No se han encontrado metaanálisis ni EPA que comparen nutrición enteral con la parenteral en ninguno de los 2 procesos estudiados, probablemente porque ya ha quedado establecido de tiempo atrás cómo realizar el tratamiento nutricional según las características clínicas concretas en cada caso de fístulas e intestino corto. Sí se han encontrado trabajos que estudian los efectos de la nutrición artificial asociada o no a nuevos fármacos o nutrientes, como somatostatina u octreótida en las fístulas digestivas, y la glutamina, la hormona de crecimiento y/o el glucagon-like peptide-2 en el intestino corto, que en algunos casos podrían ofrecer resultados prometedores en la mejoría de la evolución y pronóstico de estos 2 procesos (AU)

Gastrointestinal (GI) fistulae and short bowel syndrome are two processes in which nutritional treatment is highly important. There are evidence-based clinical practice guidelines that provide general recommendations on nutritional support in both processes. The present article reviews meta-analyses and prospective randomized trials published between 1990 and 2004 on nutritional support in GI fistulae and short bowel syndrome. No meta-analyses or prospective randomized trials comparing enteral nutrition with parenteral nutrition were found in either of the two processes studied, probably because the most appropriate forms of nutritional treatment in both entities were established some time ago. In contrast, we did find studies on the effects of artificial nutrition alone or associated with new drugs or nutrients, such as somatostatin or octreotide in GI fistulae, and glutamine, growth hormone and/or glucagon-like peptide 2 in short bowel syndrome, which in some cases could offer promising results in improving the progression and outcome of these two processes (AU)

[Parathyroid cysts. Their differential diagnosis from thyroid pathology. A report of 2 cases]. / Quistes paratiroideos. Diagnóstico diferencial con patología tiroidea. Presentación de dos casos.

Parathyroid cysts are rare in clinical practice, but, when they appear, they can be mistaken for more common thyroid conditions, that can incidentally be associated with them. We present two cases of parathyroid cysts. One of them was misdiagnosed of thyroid nodule and the other was found in the context of a normo-functioning multinodular goitre. In this last case, the presenting symptoms had raised the suspicion of malignancy. Both of them responded favorably to evacuation of the liquid by means of a puncture-aspiration with a fine needle (PAFN). Our clinical cases show that the diagnosis of parathyroid cyst should be considered in patients with a cervical mass, even if an evident thyroid condition is present. They may be accurately diagnosed by means of PAFN and determining PTH in the cystic liquid, whose characteristics help to predict its side of origin.

Quistes paratiroideos. Diagnóstico diferencial con patología tiroidea. Presentación de dos casos / Parathyroid cysts. Their differential diagnosis from thyroid pathology. A report of 2 cases

Los quistes paratiroideos son una entidad clínica poco frecuente, que se confunden a veces con procesos tiroideos, con los que se asocian ocasionalmente. Presentamos dos casos de quiste paratiroideo, uno de ellos diagnosticado erróneamente de nódulo tiroideo y el otro asociado a bocio multinodular normofuncionante, cuyos síntomas de presentación hicieron sospechar la existencia de un proceso maligno. Ambos respondieron favorablemente a la evacuación mediante punción-aspiración con aguja fina (PAAF). Nuestros casos muestran que el diagnóstico quiste paratiroideo debe considerarse en los pacientes que presentan una tumoración cervical, aún existiendo patología tiroidea evidente. Debe establecerse definitivamente mediante la PAAF y determinación de parathormona (PTH) en el líquido obtenido, cuyas características fundamentarán la sospecha clínica (AU)

[Impact of a nutrition education program on the lipid profile and food habits of a working adult population]. / Impacto de un programa educativo nutricional sobre el perfil lipídico y los hábitos alimentarios de una población adulta laboralmente activa.

To evaluate the influence of health care education of the diet, we studied, in a sample of 68 workers (47 men and 21 women), the usual food intake (by means of a weekly registration technique), the anthropometry and the lipid profile, before and after giving a nutritional information program which lasted one year. At the end thereof, we observed a significant reduction in the global caloric intake, at the expense of a lower supply of proteins and fats (mainly saturated fats), which translated into a percentile distribution of macronutrients, which more closely resembles the dietary recommendations. The average anthropometric parameters did not vary. With respect to the lipid profile, a decrease of the plasma levels of LDL and HDL cholesterol was observed. These results confirm the capacity of educational interventions in changing the eating habits to a more healthy style, with repercussions on the lipid profile.

[The consumption of food of animal origin distinct from milk: meat, fish, eggs in the school-age population of the community of Madrid. The Food Consumption and Nutritional Status of the School-Age Population of the Autonomous Community of Madrid Group]. / Ingesta de alimentos de procedencia animal distintos de la leche: carnes, pescados y huevos, en la población escolar de la Comunidad de Madrid. Grupo CAENPE.

The aim of this study was to assess the intake of foods of animal origin other than milk, as well as their role in the diet of children, in a representative sample of a school-aged population from the Community of Madrid (CAENPE study). A 4 day assessment of the dietary intake was conducted by applying a combination of the methods of 24-hour recall and a written record of the estimated consumption. We studied 2,608 schoolchildren between the ages of 6 and 14 years. The subjects were divided into groups according to age and sex. We found that the average meat intake was 213 +/- 87 g/person/day. The consumption of meat was significantly higher in boys (p < 0.05) and increased with age both in boys (p < 0.001) and girls (p < 0.05). Meat provided 40% of the saturated fat, 34% of the cholesterol and 33.5% of the protein in the diet. Fish intake was 77 +/- 64 g/person/day, with higher consumption in boys (p < 0.05) and with no influence of age. Fish supplied 11% of the dietary protein and only 1.2% of the saturated fat. Egg consumption was 31 +/- 20 g/day/person, which represents 3 eggs per week. The consumption of eggs was also higher in boys than in girls (p < 0.05) and provides 28% of the dietary cholesterol. We conclude that meat provides more than one third of the dietary protein and alone covers the RDA for protein. In addition, meat also contributes the highest amount of dietary saturated fat and cholesterol. Egg and fish intake is adequate; hence, it would be desirable to reduce the excessive meat intake in order to equilibrate the macronutrients and cholesterol supplied by the diet.

[The consumption of dairy products and their contribution to the nutrients in the diet of schoolchildren in the community of Madrid. The Food Consumption and Nutritional Status of the School-Age Population of the Autonomous Community of Madrid Group]. / Consumo de lácteos y su contribución al aporte de nutrientes en la dieta de los escolares de la Comunidad de Madrid. Grupo CAENPE.

The aim of this report, included in the CAENPE study, was to assess the actual intake of milk products by children from Madrid and their nutrient contribution to the diet. In a sample of 2,608 children, 1,343 boys and 1,265 girls, between 6 and 14 years of age, representative of the school child population from Madrid, a dietary assessment of 4 non-consecutive days was carried out by applying a combination of the methods of 24-hour recall (2 days) and an estimated food intake record (2 days). We found that the average total milk product intake was 410 +/- 173 g/person/day, with this being significantly higher in boys (p < 0.0001) and increasing with age (p < 0.001). Milk products are the primary source of calcium, 1,076 +/- 374 mg/person/day, which represents 61% of the total calcium intake and is below the RDA for children over 10 years of age. In addition, following meat and meat products, dairy products are the second largest source of saturated fat (28% of total intake). They also supply 31% of the dietary phosphorus, 17% of protein, 16% of total fat, 15% of the cholesterol, 10% of the carbohydrates and 14% of the the energy intake. We conclude that milk products are the major source of calcium in the diet of schoolchildren. Their low consumption explains the insufficient calcium intake in certain age groups, which might be associated to a higher risk of osteoporosis in later life. We encourage an increase in the intake of milk products, especially milk, and a reduction in the consumption of sweets and meat in order to decrease the dietary saturated fats.

[Small-cell bronchogenic carcinoma with ectopic secretion of ACTH: apropos of 2 cases and review of the literature]. / Carcinoma broncogénico de células pequeñas con secreción ectópica de ACTH: a propósito de dos casos y revisión de la literatura.

Described in this report are 2 patients with small-cell bronchogenic carcinoma with ectopic secretion of ACTH, an association that has long been reported in the literature but that is nevertheless rare, with most authors describing small series of patients or reporting retrospective studies. Pathogenic and etiological aspects are reviewed, with emphasis on the scarcity of clinical signs and the biochemical criteria needed for diagnosis. The poor prognosis of the disease is discussed along with the need to try to treat hypercortisolism even before cytotoxic therapy is initiated.