Glycemic control in patients with type 2 diabetes mellitus with a disease-specific enteral formula: stage II of a randomized, controlled multicenter trial.

BACKGROUND: Stage I of a preplanned 2-stage study has provided good evidence for improved glycemic control with a disease-specific enteral formula low in carbohydrates and high in monounsaturated fatty acids (MUFAs), fish oil, chromium, and antioxidants in insulin-treated type 2 diabetes. The study was continued with stage II to give confirmatory proof of these beneficial effects. METHODS: 105 patients with HbA1C>or=7.0% and/or fasting blood glucose (FG)>6.7 mmol/L (>120 mg/dL) requiring enteral tube feeding due to neurological dysphagia received 113 kJ (27 kcal)/kg body weight of either test formula (Diben) or an isoenergetic, isonitrogenous standard formula (control) for up to 84 days. Total insulin (TI) requirements, FG, and afternoon blood glucose (AG) were assessed daily. HbA1C and safety criteria were evaluated on days 1, 28, 56, and 84. RESULTS: 55 patients completed the study; on day 84, median changes from baseline (data as available, test vs control) were the following: TI, -8.0 vs +2.0 IU; FG, -2.17 vs -0.67 mmol/L (-39.0 vs -12.1 mg/dL); HbA(1C), -1.30% vs -1.20%; AG, -2.36 vs -0.49 mmol/L (-42.5 vs -8.9 mg/dL). The number of relevant hypoglycemic episodes (FG<3.33 mmol/L<60 mg/dL) was 1 vs 5. Feeding tolerance was comparable in both groups. CONCLUSIONS: Long-term tube feeding with a disease-specific enteral formula was safe and well tolerated in type 2 diabetic patients with neurological disorders. When compared with a standard diet, TI requirement decreased significantly with less hypoglycemia whereas FG and AG were significantly lowered, resulting in improved glycemic control.

[Hepatopulmonary syndrome causing severe hypoxaemia].

Dyspnoea is a common complaint in patients with chronic liver disease. Hepatopulmonary syndrome (HPS) is an important cause to be aware of in the setting of liver disease, dyspnoea and hypoxaemia. HPS causes microvascular dilatation, angiogenesis and arteriovenous bypassing. The patients suffer from hypoxaemia in upright position and even during minimal psychical activity. Contrast echocardiography, using micro-bubbles as the contrast, is required to establish the diagnosis. No medical therapy is available, only liver transplantation can cure the disease.

Barrett's esophagus. Diagnosis, follow-up and treatment.

Barrett's Esophagus (BE) is a premalignant condition in the esophagus. Esophageal adenocarcinomas have the fastest increase of incidence of all solid tumors in the western world. BE is defined as areas with macroscopic visible columnar epithelium and intestinal metaplasia oral of the anatomical gastroesophageal junction. The extent of the endoscopic findings is described by the Prague classification. The metaplasia is histologically confirmed by the presence of intestinal metaplasia. The diagnosis of BE can only be made by a combined macroscopic and microscopic examination. The histological description should include evaluation of dysplasia, and if present it should be classified as low or high grade dysplasia. All patients are offered relevant antireflux treatment with PPI or surgery. Ablation or mucosal resection of metaplastic epithelia with or without low grade dysplasia is experimental and it is not recommended outside controlled studies. Treatment of high grade dysplasia and carcinoma in situ is handled in departments treating esophageal cancer. Follow-up with endoscopy and biopsy can be offered. Follow-up endoscopy with biopsy can only be recommended after thorough information to the patients, as evidence for the value is scarce.

Cytogenetic effects of 18.0 and 16.5 GHz microwave radiation on human lymphocytes in vitro.

BACKGROUND: There are few cell studies on the direct genotoxic effects of microwave radiation. In this study, cytogenetic effects of microwave radiation alone or in combination with mitomycin C (MMC) were investigated. MATERIALS AND METHODS: Lymphocytes from two smoking and four non-smoking donors were exposed for 53 hours in vitro to 1.0 W/m(2) continuous-wave radiation at 18.0 GHz or 10 W/m(2) pulsed-wave at 16.5 GHz, alone or in combination with MMC. DNA synthesis and repair were inhibited in vitro in some cultures. RESULTS: No synergistic effect was observed in cells exposed to combinations of microwave radiation and in vitro exposure to MMC, or to cells pre-exposed in vivo to tobacco smoke. For the 16.5 GHz pulsed exposure, a non-significant trend consisting of an increase in aberration frequencies with microwave radiation was shown for the DNA synthesis and repair inhibited cultures both with and without MMC. CONCLUSION: Neither 18.0 GHz continuous-wave nor 16.5 GHz pulsed-wave exposure to human lymphocytes in vitro induced statistically significant increases in chromosomal aberration frequencies. 16.5 GHz pulsed-wave exposure requires further documentation before a true negative conclusion can be drawn.

Cytogenetic effects of exposure to 2.3 GHz radiofrequency radiation on human lymphocytes in vitro.

BACKGROUND: No previous in vitro studies have tested radio frequency radiation for at least one full cell cycle in culture. The aim was to test if exposure used in mobile phones and wireless network technologies would induce DNA damage in cultured human lymphocytes with and without a known clastogen. MATERIALS AND METHODS: Lymphocytes from six donors were exposed to 2.3 GHz, 10 W/m(2) continuous waves, or 2.3 GHz, 10 W/m(2) pulsed waves (200 Hz pulse frequency, 50% duty cycle). Mitomycin C was added to half of the cultures. DNA synthesis and repair were inhibited in one experiment. RESULTS: No statistically significant differences were observed between control and exposed cultures. A weak trend for more chromosomal damage with the interaction of pulsed fields with mitomycin C compared to a constant field was observed. CONCLUSION: Exposure during the whole cell cycle in inhibited cultures did not resulted in significant differences in chromosomal aberrations as compared to controls.

[Severe diarrhea after the original well-functioning percutaneous endoscopic gastrostomy tube was replaced by a Mic-Key button]. / Svaer diaré efter skift fra velfungerende perkutan endoskopisk gastrostomisonde til Mic-key-knap.

We report two cases of colocutaneous fistula as a complication of percutaneous endoscopic gastrostomy (PEG) in small children. Both children developed severe osmotic diarrhoea immediately after the original PEG tube was replaced by a Mic-Key button which subsequently migrated to the colon.