A polyol-stevia blended sugar replacer exhibits low glycemic response among human subjects.

BACKGROUND & AIMS: Consumption of sugars in food and beverages has increased at an alarming rate. While excessive daily sugar intake has been well-associated as the onset of medical complications, additional sugars are still used in manufactured food products just to satisfy the consumers' needs. Hence, there is a need to develop sugar replacers that have low glycemic response without compromising the organoleptic characteristics of food products. This study aimed to determine if SUITENA™, a novel sweetener containing erythritol, xylitol, and Stevia, has low glycemic response upon consumption by human subjects. METHODS: Six human subjects were randomly chosen and were healthy at the point of experimentation. Capillary blood was collected via finger-prick method to monitor the glycemic response of every individual for 90 min after ingestion of sugar solution. RESULTS: It was found that the mean area under the curve (AUC) of the dextrose standard was 11.8-fold higher (p < 0.05) than the AUC of SUITENA™. SUITENA™ was not able to increase blood glucose level for up to 90 min while a spike in blood glucose level was observed from 15 min post-consumption of dextrose solution. We found that SUITENA™ has elicited a glycemic response 8% relative to the standard. Such low glycemic response has been reported by studies on other novel sugars. CONCLUSION: This preliminary finding suggested that SUITENA™ is a healthier alternative to fast sugars due to its low glycemic response. A larger sampling size is required to confirm the results.

Theory of monolayers with boundaries: exact results and perturbative analysis.

Domains and bubbles in tilted phases of Langmuir monolayers contain a class of textures known as boojums. The boundaries of such domains and bubbles may display either cusplike features or indentations. We derive analytic expressions for the textures within domains and surrounding bubbles, and for the shapes of the boundaries of these regions. The derivation is perturbative in the deviation of the bounding curve from a circle. This method is not expected to be accurate when the boundary suffers large distortions, but it does provide important clues with regard to the influence of various energetic terms on the order-parameter texture and the shape of the domain or bubble bounding curve. We also look into the effects of thermal fluctuations, which include a sample-size-dependent effective line tension.

Delphi-panel analysis of appropriateness of high-dose chemotherapy and blood cell or bone marrow autotransplants in diffuse large-cell lymphoma.

Although high-dose chemotherapy and a blood cell or bone marrow autotransplant are commonly used to treat people with diffuse large-cell lymphoma, there is controversy whether this is better than conventional-dose chemotherapy. Subject-selection and time-to-treatment biases preclude comparison of data from uncontrolled trials and there are few date from randomized trials. We used a Delphi-panel group judgment process to determine appropriateness of high-dose chemotherapy and a blood cell or bone marrow transplant. Results were compared to those of randomized trials. Nine lymphoma experts from diverse geographic sites and practice settings were panelists. Boolean MEDLINE searches of lymphoma and chemotherapy and an autotransplant formed the dataset. Panelists were asked to rate appropriateness of high-dose chemotherapy and an autotransplant compared to conventional-dose chemotherapy. Clinical variables were permuted to define 80 clinical settings rated by the panelists on a 9-point ordinal scale. Results were used to determine an appropriateness index reflecting the mean and distribution of ratings. The relationship of appropriateness indices to permuted clinical variables was considered by analysis of variance and recursive partitioning. In people with initial diffuse large-cell lymphoma, autotransplants were never rated appropriate. They were rated uncertain in all settings except in people never receiving chemotherapy and in those with a complete response to chemotherapy and an international prognostic index < 3, where they were rated inappropriate. In people with recurrent lymphoma, autotransplants were rated appropriate in those with a complete or partial response to chemotherapy, uncertain in those with a less than partial response and in those not receiving re-induction chemotherapy and inappropriate in people with CNS lymphoma. These conclusions agree with results of randomized trials.

Allogeneic and autologous bone marrow transplant experiences in Hawaii.

Allogeneic bone marrow transplant (BMT) was first performed successfully at St. Francis Medical Center in 1978. Since that time, 91 BMTs have been performed for aplastic anemia, leukemia, lymphoma, and Stage II, III and IV breast cancers. This article will explain the methods, complications and results of BMT in Hawaii.

Ingested foreign body in young children.

Locally, ingested foreign body is a problem commonly seen in the adult patients. Paediatric patients constituted about 6.5% of all cases of ingested foreign body. In adults and older children who are able to communicate, the management is usually straight forward. However, the diagnosis of ingested foreign body in a prelingual child may pose a problem as the child is unable to talk. A high index of suspicion is needed in the diagnosis of ingested foreign body. This article presents a case of undiagnosed ingested foreign body causing pharyngeal perforation with retropharyngeal abscess in a two year-old boy. The management of ingested foreign body in young children is discussed.

Prognostic factors in idiopathic sudden hearing loss.

A retrospective study of 60 cases of idiopathic sudden hearing loss admitted to the Department of Otolaryngology, Singapore General Hospital over a five year period was carried out. The age ranged from 16 years to 74 years. No racial predisposition was found. All cases were treated as an otological emergency and managed as inpatients. All were treated with high dose steroids. Fifty-five percent recovered their hearing significantly. Several factors associated with poorer recovery of hearing were found: severity of hearing loss; high tone loss; longer time from onset to initial audiogram; hypofunctioning vestibular organ and age older than 60 years and under 19 years.

Results of surgery to the damaged facial nerve.

Neurological surgery of the paralysed face can be rewarding if performed early using appropriate surgical techniques. The results of 32 operations are analyzed. Excellent restoration of facial function is achieved with early surgical intervention but some results are poor. The reasons for failure are analyzed.

Middle ear diseases in cleft palate patients in Singapore.

A preliminary prospective study of the correlation between middle ear diseases and cleft palate was started in February 1987. Eighty three patients from the Plastic Surgical Department of the Singapore General Hospital have been screened. Three quarters of the ears screened were normal. Middle ear effusion was the commonest disease especially in younger children found in eighteen of thirty four abnormal ears; all these patients benefited from myringotomy and insertion of a ventilating tube. Other types of middle ear disease included adhesive otitis media, perforation of the eardrum, attic retraction and cholesteatoma; these were found predominantly in older patients. The incidence of middle ear disease was 23% in Chinese patients with cleft palate as compared with up to 90% in Caucasian patients.

Surgery of major congenital aural atresia.

Accurate preoperative clinical, audiometric and radiographic evaluation is a prerequisite for surgery of major congenital aural atresia, which is accepted as one of the most difficult otological reconstructive procedures to perform. The main aim is to achieve serviceable hearing. Middle ear and facial nerve anomalies and functional results of eleven consecutive primary operations by one of the authors are presented. Familiarity with various Tympanoplastic and Facial nerve surgical techniques is mandatory.

Sudden cardiac death following adriamycin therapy.

An 18-year-old man had had an osteogenic sarcoma of the distal tibia at age 16. Below-knee amputation was carried out and followed by adjuvant chemotherapy with Adriamycin, vincristine, methotrexate, Cytoxan, and melphalan. One month after termination of chemotherapy, he died suddenly while playing tennis. Documented ventricular fibrillation was unresponsive to cardiopulmonary resuscitation. Myocardial fibrosis ("cardiomyopathy") was the only significant anatomic finding at autopsy. The occurrence of sudden death without antecedent cardiac failure may have been related to strenuous physical activity in this patient who had received combined adjuvant chemotherapy.

Adriamycin, bleomycin, DIC, CCNU, and prednisone (ABDIC) chemotherapy in MOPP-resistant Hodgkin's disease.

ABDIC was administered to 32 patients with MOPP-resistant Hodgkin's disease. Three were considered nonevaluable because of early death. All patients had received MOPP (medium of eight cycles), and five had also received other chemotherapy. Major radiotherapy had been used in 18 of the 29. Complete remission (CR) occurred in 10 of 29 (34.5%), partial remissions (PR) in 14 (48.2%), and no remissions (NR) in five (17.2%). Median survival and relapse-free survival for CR patients exceeded 28 months. Two relapsed at 8 and 18 months; one died at 9 1/2 months, and the other is disease-free with other treatment at 35 months. Seven of the remaining eight patients are alive without disease (10-35 months); 4 are on maintenance therapy, and the other died from an infection and eosinophilic granuloma of lung without evidence of recurrent Hodgkin's disease. Median survival of PR patients was eight months. One patient with Hodgkin's disease involving the liver is alive at 36 months with further therapy. Median survival of NR patients is 2.5 months, and all died within seven months. Survival of CR patients is greater than PR and NR patients (P = 0.002), and that of PR is greater than NR (P = 0.01). Four of the 29 patients had nodal relapse, and 25 had parenchymal relapse, with no difference in response rates (P = 0.47). ABDIC is useful in Hodgkin's disease patients who have had extensive prior chemotherapy and radiotherapy.

The efficacy of percutaneous liver biopsy in the initial staging of patients with lymphoma.

To evaluate the usefulness of percutaneous needle liver biopsy in the initial staging of lymphoma patients, 115 patients presenting to M. D. Anderson Hospital between Sept 1, 1972, and Aug 31, 1975, and having either percutaneous (45) or celiotomy (70) liver biopsy were identified. Sixty-six patients had Hodgkin's disease, 49 non-Hodgkin's lymphoma. Overall, results of 13 biopsies were positive--six by percutaneous biopsy, seven by celiotomy. Results showed little difference in yield between percutaneous and celiotomy biopsy. Positivity increased with increasing clinical stage, increasing age (Hodgkin's patients), and increasing number of abnormal liver function tests. It is concluded that percutaneous liver biopsy is useful in lymphoma staging, especially in patients with at least one abnormal liver function test, and in patients with Hodgkin's disease, mixed cell type. The early identification of otherwise unrecognized stage IV disease can spare many patients the morbidity of staging celiotomy.

Radiation-related myocardial injury. Management of two cases.

Pericardial effusion and trifascicular block developed 5 years following mediastinal irradiation for Hodgkin's disease in a 19-year-old patient. Another 24-year-old patients had an acute myocardial infarction followed by severe angina pectoris 5 years following mediastinal irradiation for the same disease. A pericardial window and a permanent demand pacemaker were used in the first case; an aorto-coronary vein grafting was utilized in the second patient. Both patients responded to treatment and are well. Five other previously reported cases of myocardial injury that occurred 2 months to 8 years following mediastinal irradiation in young patients were reviewed. To our knowledge, successful surgical treatment of this disease entity has not been reported before. Close, long-term follow-up of patients who have received mediastinal irradiation should be helpful in the early recognition and successful management of these serious cardiac complications. The systematic clinical and radiographic surveilance of these patients should be supplemented by a routine 12-lead electrocardiogram.