Associations between food portion sizes, insulin resistance, VO2 max and metabolic syndrome in European adolescents: The HELENA study.

BACKGROUND AND AIMS: This study aims to examine the associations of food portion size (PS) with markers of insulin resistance (IR) and clustered of metabolic risk score in European adolescents. METHODS: A total of 495 adolescents (53.5% females) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study were included. The association between PS from food groups and homeostasis model assessment of insulin resistance (HOMA-IR) index, VO2 max, and metabolic risk score was assessed by multilinear regression analysis adjusting for several confounders. Analysis of covariance (ANCOVA) was used to determine the mean differences of food PS from food groups by HOMA-IR cutoff categories by using maternal education as a covariable. RESULTS: Larger PS from vegetables in both gender and milk, yoghurt, and milk beverages in males were associated with higher VO2 max, while larger PS from margarines and vegetable oils were associated with lower VO2 max (p < 0.05). Males who consumed larger PS from fish and fish products; meat substitutes, nuts, and pulses; cakes, pies, and biscuits; and sugar, honey, jams, and chocolate have a higher metabolic risk score (p < 0.05). Males with lower HOMA-IR cutoff values consumed larger PS from vegetables, milk, yoghurt, and milk beverages (p < 0.05). Females with lower HOMA-IR cutoff values consumed larger PS from breakfast cereals, while those with higher HOMA-IR cutoff values consumed larger PS from butter and animal fats (p = 0.018). CONCLUSION: The results show that larger PS from dairy products, cereals, and high energy dense foods are a significant determinant of IR and VO2 max, and larger PS from food with higher content of sugar were associated with higher metabolic risk score.

Development and evaluation of a self-administered computerized 24-h dietary recall method for adolescents in Europe.

OBJECTIVE: To describe the development of a European computerized 24-h dietary recall method for adolescents, and to investigate the feasibility of self-administration (self report) by comparison with administration by a dietician (interview). METHODS: Two hundred and thirty-six adolescents (mean age 14.6 years (s.d.=1.7)) of eight European cities completed the 24-h recall (Young Adolescents Nutrition Assessment on Computer (YANA-C)) twice (once by self-report and once by interview). RESULTS: A small but significant underestimate in energy (61 (s.e.=31) kcal) and fat (4.2 (s.e.=1.7) g) intake was found in the self-reports in comparison with the interviews; no significant differences were found for the intake of carbohydrates, proteins, fibre, calcium, iron and ascorbic acid. Spearman's correlations were highly significant for all nutrients and energy ranging between 0.86 and 0.91. Agreement in categorizing the respondents as consumers and non-consumers for the 29 food groups was high (kappa statistics >or=0.73). Percentage omissions were on average 3.7%; percentage intrusions: 2.0%. Spearman's correlations between both modes were high for all food groups, for the total sample (>or=0.76) as well as for the consumers only (>or=0.72). Analysing the consumer only, on an average 54% of the consumed amounts were exactly the same; nevertheless, only for one group 'rice and pasta' a significant difference in consumption was found. CONCLUSION: Adaptation, translation and standardization of YANA-C make it possible to assess the dietary intake of adolescents in a broad international context. In general, good agreement between the administration modes was found, the latter offering significant potential for large-scale surveys where the amount of resources to gather data is limited.

[Value of stereotactic breast core biopsy in patients with atypical ductal hyperplasia]. / Valeur des macrobiopsies mammaires sous guidage stéréotaxique en cas de découverte d'une hyperplasie canalaire atypique.

PURPOSE: Based on a dual center retrospective study, the risks of under-diagnosing clusters of microcalcifications on core biopsies are analyzed. Imaging and histopathological factors affecting this risk are explored. MATERIALS AND METHODS: A total of 1,400 lesions (ACR BI-RADS 2-5) were reviewed and analyzed for size, degree of excision (%), and histology result. A total of 381 patients underwent surgery. Inter-center review of some histological slides was also performed. RESULTS: The rate of under-diagnosis was 5.9% for ductal carcinoma in-situ (DCIS) and 12.5% for atypical ductal hyperplasia (ADH). Most cases of under-diagnosis involved clusters larger than 20 mm in diameter where the percentage of excision decreased from 98% (clusters<10 mm) to 9%. Review of histological slides showed inter-observer variability that decreased in relation to experience. ADH was never under-diagnosed when 3 or less foci were present. The risk of under-diagnosis for DCIS increased when the number of biopsies containing DCIS was superior to 50% and if the grade was high. CONCLUSION: The presence of ADH on biopsy specimens requires surgical biopsy, but optimal core biopsies with cluster removal and histological analysis by an experienced observer allows identification of low risk patients that could undergo close follow-up.

Adenomas of the rete ovarii.

This article reports the clinicopathological and immunohistochemical findings of two cases of adenoma of the the rete ovarii (RO), one unilateral and the other bilateral, presenting with atypical histological features in the right ovary. Both tumors were incidental findings in 62- and 64-year-old patients presenting with metrorrhagia. The predominantly cystic lesions measured 2 cm and 3 cm in diameter and microscopically, they were tubulopapillary proliferations of regular columnar cells with clear cytoplasm. The stroma showed extensive differentiation of polygonal, Leydig-like cells which was associated in both cases with simple endometrial hyperplasia. In both cases rete and hilar mesonephric remnants were found in the vicinity of the lesion. The atypical lesion in one case had a complex papillary proliferation different in pattern and cellularity from a retiform Sertoli-Leydig cell tumor. It showed extensive areas of eosinophilic change, pleomorphism, and a few mitoses but did not invade the adjacent ovarian stroma. Its stroma also had steroidally active cells. The patient was alive and well after a follow-up interval of 3 years. Immunohistochemically, the lesions were diffusely positive for CAM 5.2, vimentin, epithelial membrane antigen, OC 125, OC 125, and progesterone receptors.

Dietary estimated intake of intense sweeteners by Italian teenagers. Present levels and projections derived from the INRAN-RM-2001 food survey.

In a previous study, Italian female teenagers regular consumers of sugar free soft drinks and table-top sweeteners were suggested to have a higher intake of intense sweeteners than other teenagers. A food frequency questionnaire designed to identify adolescents who were high consumers of these food products was filled in by a randomly extracted sample of teenagers (n=3982) living in the District of Rome (Italy) in year 2000. A consumer survey was then carried out in a randomly extracted sub-sample of males and females and in all females who reported high consumption of sugar-free soft drinks and/or table-top sweeteners. A total of 362 subjects participated in a detailed food survey by recording, at brand level, all foods and beverages ingested over 12 days. For each sugar-free product, producers provided the concentration of intense sweeteners (saccharin, aspartame, acesulfame K and cyclamate). No intake in excess of the Acceptable Daily Intake (ADI) was observed. Also medicines and supplements were taken into account and these did not result in a large impact on chronic exposure to intense sweeteners. The intake levels did not exceed the ADI even under a worst case scenario which was performed to take into consideration a hypothetical future substitution of all regular food products with their sugar-free version. It can be concluded that, with the observed current consumption patterns and occurrence levels, the risk of an excessive intake of intense sweeteners by Italian teenagers is extremely low.

Clinical prevalence of glomerular hematuria: a nine-year retrospective study.

The authors evaluated red blood cell (RBC) morphology by phase contrast microscopy and identified casts and lipidic material in 4,448 urine sediments (US). Microhematuria was discovered on systematic examination in 1,186 apparently healthy patients (group I). Another 4,362 patients (group II) with microscopic or gross hematuria were being treated or evaluated for various renal or extrarenal diseases (renal transplantation excepted). Glomerular hematuria (GH) was observed in 93.1% of group I patients and in 58.0% of group II patients. GH and non-GH were observed together in 0.6% of cases. The origin of hematuria remained uncertain in 11.6% of cases. In GH, the other cytological findings were as follows: RBC casts were seen in 5.3% of group I and 20.5% of group II; granular and/or cellular casts were seen in 12.8% of group I and 39.6% of group II; and lipidic material was seen in 0.6% of group I and 8.8% of group II. Both groups showed a higher frequency of RBC casts, granular and/or cellular casts, and lipidic material in patients under 20. This method of investigation of urine, which is simple, rapid, inexpensive, and noninvasive, provides useful information for the clinician and avoids unnecessary investigations.

Magnetic antibody immunoassay thyroid function tests in general practice.

Commercial radioimmunoassay kits for the measurement of human total thyroxine (T4) and total triiodothyronine (T3) based on magnetic separation are discussed for use in dogs and cats. The T4 assay procedure is modified to increase the accuracy over normal canine and feline ranges using four standards from kit components provided. Results of validation are presented and indicative normal ranges given: canine T4, 0.94 to 3.45 micrograms/dl; canine T3, 0.36 to 1.52 ng/ml; feline T4, 1.34 to 4.70 micrograms/dl; feline T3, 0.23 to 0.95 ng/ml. There is a significant breed difference in T4 levels between poodles and Yorkshire terriers.

[A new biomaterial in surgery of ptosis with frontalis suspension: wide pore PTFE]. / Un nouveau biomatériau dans la chirurgie du ptosis avec suspension au muscle frontal: le PTFE à larges pores.

BACKGROUND: In brow suspension, there is agreement that fresh tissue (autogenous fascia lata or temporalis fascia) provides the best results in terms of low complications and duration of the effect. Yet, the morbidity of fresh tissue harvesting is not negligible. Many alternative materials have disadvantages in terms of duration of the procedure and side effects. METHODS: We have used a new material: wide porous expanded polytetrafluoroethylene (eP.T.F.E.). This material is an inert vitreous teflon alloplast with a high biocompatibility. It is close to Gore-Tex, but differs from it by a higher porosity (over 90%) and wider diameter of its pores (over 50 mus). We performed a series of 60 brow suspension from February 1992 to March 1994, using this new material. RESULTS: We did not encounter any significant complications due to the material and in circumstance, we did not deplore any migration, infection or extrusion of the ePTFE. The biocompatibility seems to be increased, as it has been demonstrated by light and electron microscopy of the implanted material who revealed that fibrovascular ingrowth was significantly achieve two months after surgery. CONCLUSION: The first results of this series are very encouraging. They can favourably be compared with the results of other series using different types of materials available in brow suspension. Though our longest follow-up is 30 months, further study is necessary to evaluate the long term results and eventual long term side effects of ePTFE, which avoid harvesting fresh tissues, thus reducing the brow suspension procedure's morbidity.

[Lipomyxosarcoma of the pulmonary veins extending into the left atrium. Repetitive surgical treatment]. / Lipomyxosarcome des veines pulmonaires à extension intra-auriculaire gauche. Cures chirurgicales itératives.

The case reported here of a 54-year old woman with lipomyxosarcoma of the pulmonary veins successfully excised is the first in the literature. The initial symptoms were febrile left ventricular failure with pulmonary oedema and haemoptysis. The diagnosis was made by angiocardiography. The tumour was excised in two stages: cardiac first, under cardiopulmonary bypass, then thoracic with left pneumonectomy. Two years after surgery, the patient is in good condition without chemotherapy.

Potential and requirements for a standardized pan-European food consumption survey using the EPIC-Soft software.

BACKGROUND/OBJECTIVES: To describe the strengths, limitations and requirements of using EPIC-Soft software (the software developed to conduct 24-h dietary recalls in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study) in pan-European food consumption surveys, and to discuss potentials and barriers for a harmonized pan-European food consumption survey. SUBJECTS/METHODS: The paper is based on the experiences in the 'European Food Consumption and Validation' Project, which included updating six existing and preparing one new country-specific EPIC-Soft version, applying EPIC-Soft in validation and feasibility studies, and estimating the intake of nutrients and flavoring substances. The experiences were discussed in the September 2009 workshop 'Pan-European Food Consumption Surveys--for Standardized and Comparable Transnational Data Collection'. RESULTS: EPIC-Soft is suitable for detailed and standardized food consumption data collection in pan-European food consumption surveys. A thorough preparation of all aspects of the food consumption survey is important for the quality and efficiency during data collection and processing. The preparation and data-handling phase of working with EPIC-Soft is labor intensive and requires trained, motivated and qualified personnel. CONCLUSIONS: Given the suitability of EPIC-Soft as standardized dietary assessment tool in European dietary monitoring, the proposed strategy toward a pan-European food consumption survey is to prepare well, to allow flexibility in national extensions and to start with a limited number of countries that are interested.

Design and preparation of market baskets of European Union commercial baby foods for the assessment of infant exposure to food chemicals and to their effects.

The assessment of acute and chronic dietary exposure to contaminants in baby foods is needed to ensure healthy infant growth. Monthly European Union market baskets of commercial baby foods were designed for the first 9 months of life by the 'babyfood' study group of the CASCADE Network of Excellence for the specific purpose of assessing exposure to potentially toxic substances in infants fed with such foods. The present paper reports the different steps that led to the preparation of monthly pooled samples of commercial baby foods ('Infant formulae and follow-on formulae' and 'Other baby foods') that may constitute the extreme case of the diet for an infant who would not be breast fed at all. Several market baskets were generated for an 'average European Union infant' and for infants of four selected countries (Italy, Sweden, Spain, and the Slovakia), fed with either milk infant formulae, soy infant formulae or hypoallergenic infant formulae and weaned (at the fifth month) with commercial baby foods and beverages available on the European Union market. Market share data for 2007 for baby foods were used to design the baskets. Holding companies and the name of all their products were identified. Monthly diets for European Union infants were elaborated in terms of food categories (e.g. infant cereals) of typologies of products (e.g. infant cereals without gluten) and of a specific product. The number of baskets generated was 30 for 'Infant formulae and follow-on formulae' (including 62 products) and 13 for 'Other baby foods' (including 35 products). These market baskets were designed to be used for the determination of certain contaminants and nutrients in the diet of European Union infants and for the assessment of their effects on infant health.

Dietary exposure to flavouring substances: from screening methods to detailed assessments using food consumption data collected with EPIC-Soft software.

This study aimed to compare different methods of assessing dietary exposure to flavourings in the context of a stepwise approach. The dietary exposure to four flavourings--raspberry ketone, glycyrrhizinic acid, coumarin, and caffeine--was determined. When dietary exposure exceeded the safety limits, the need for more detailed assessment using less aggregated data was judged necessary. First, screening methods--maximized survey-derived daily intake (MSDI), single-portion exposure technique (SPET), and modified theoretical added maximum daily intake (mTAMDI)--were applied. Next, individual food consumption data were used for creating models with different levels of detail to identify the foods: a model based on food groups and models based on food items. These were collected from 121 Dutch adults using a standardized 2 x 24-h dietary recall (EPIC-Soft) in the European Food Consumption Validation (EFCOVAL) study. Three food item models were developed: without improvements of the flavouring descriptor built in the software; with improvements; and with use of non-specified flavour descriptors. Based on the results of at least one of the three screening methods, refined assessment was necessary for raspberry ketone, glycyrrhizinic acid, and caffeine. When applying the food group model, the need for refinement was indicated for the four flavourings. When applying the food item models, only glycyrrhizinic acid and caffeine presented dietary exposure above the safety limits. In the raspberry ketone case, dietary exposure increased when improvements in food description were considered. The use of non-specified flavour descriptors hardly changed the results. The collection of detailed food consumption data at the individual level is useful in the dietary exposure assessment of these flavourings.

Dietary exposure to chemicals within the process of risk assessment: possible applications to substances that may cause allergic reactions.

Exposure assessment is one of the key parts of the risk assessment process. This task is crucial when evaluating substances for which only intake of toxicologically-important amounts can lead to adverse health effects. Ideally, dietary exposure to hazardous substances can be assessed by combining data on concentration in all food products with data on their consumption. However, it is considered to be neither cost-effective nor necessary to collect detailed data for every substance, and a stepwise procedure is commonly used to focus resources on the most important issues. Screening methods, designed to look for 'worst case' situations, are first used to target chemicals that might be of health concern for the general population or for certain at-risk groups. The quality of the dietary exposure assessments not only depends on the quality of the data collected, but also on the integration tools used for initial screening or for the eventual more precise estimations. A particular challenge is the evaluation of food allergens and components causing other forms of intolerances, since no reliable data seem to be currently available on the type of exposure (amounts and duration) required to induce a food allergy. A different approach from that used for dietary exposure to other hazardous substances has to be adopted. However, the methodologies (such as those used to collect food consumption data) and databases (in particular, information about food labels) developed in such a context could be useful to investigate the exposure conditions leading to the development of food allergies.

Food consumption and nutrient intake in a sample of Italian secondary school students: results from the INRAN-RM-2001 food survey.

The present study was designed to estimate the average food and nutrient intake in a sample of Italian students living in the District of Rome. In the school year 1999-2000 all students belonging to the first, second or third year of nine randomly selected secondary public schools were contacted for filling in a food frequency questionnaire (3982 subjects). The next year, 233 of them (125 males and 108 females), randomly extracted, participated in a detailed food survey. Food intake was assessed on the basis of 12 (four consecutive days in three different periods) 24-h dietary records. The average daily intakes of fruit (107 +/- 100 g/day), vegetables (186 +/- 74 g/day) and legumes (16 +/- 29 g/day) were lower than recommended. The percentage of energy intake from fat (39%) and that from saturated fats (12%) were high. On the other hand, the percentage of energy intake from carbohydrates was low (45%) even if that from sugar (14%) was rather high. The students' diet was characterized by low intakes of fibre (16 +/- 6 g/day) and calcium (710 +/- 247 mg/day) in both males and females. Iron intakes were lower than 12 mg/day in a very high percentage of females (80%), suggesting that iron deficiency may be present in this population group. Results indicate that the diet of these students is both unbalanced in terms of macronutrients and deficient for some micronutrients, suggesting the need for intervention.

Bronchiolitis obliterans organizing pneumonia associated with minocycline therapy: a possible cause.

We report the case of a woman who presented with dyspnoea whilst taking minocycline for acne. Imaging features of bilateral patchy alveolar opacities suggested a diagnosis of bronchiolitis obliterans organizing pneumonia, which was confirmed by lung biopsy. The patient improved, partially, after stopping minocycline, and then completely on treatment with corticosteroids, without relapse when these where stopped 8 weeks later.

Adenocarcinoma of the urachus showing extensive calcification and stromal osseous metaplasia.

We report a case of adenocarcinoma of the urachus showing extensive calcification and stromal osseous metaplasia, arising in the bladder dome of a 51-years-old man. The patient underwent partial cystectomy, including in block excision of the entire urachus and umbilicus, and remains well, free from symptoms after a 22-month follow-up period. Main pathologic and clinical characteristics of urachal calcified tumors are reviewed. To our knowledge, this is the first report in the English literature on urachal carcinoma showing both extensive scattered calcification and massive stromal osseous metaplasia.

[Pheochromocytoma and aortocoronary bypass. Double surgical procedure]. / Phéochromocytome et pontage aorto-coronaire. Double intervention chirurgicale.

Based on a personal case of a 47 year old woman with an adrenal medullary pheochromocytoma and stenosis of the left anterior descending artery treated by aorto-coronary bypass grafting after ablation of the pheochromocytoma, the authors illustrate the frequency and precocity of organic coronary artery disease in 27 cases in the literature. Chest pain and electrocardiographic changes are often attributed to functional ischaemia but the high incidence of organic coronary artery disease in the series analysed confirms the need for coronary angiography in doubtful cases. It is reasonable to start by removing the pheochromocytoma and, only then, consider coronary angiography with a view to coronary bypass surgery: the risks of a hypertensive crisis seem to be reduced when this protocol is followed.

Surgical management of late prosthetic valve endocarditis.

Among 32 patients with late prosthetic valve endocarditis selected from two cooperative retrospective studies, ten had valve replacement: six men and four women, mean age being 48 years, ranging from 23 to 65 years old. An emergency reoperation was undertaken for refractory heart failure in seven out of ten cases, with an average delay of 6.6 days after the beginning of antibiotic therapy. In the other three cases, the operation was carried out at the end of 40 days of antibiotic therapy, once for recurrent endocarditis and twice for severe aortic insufficiency. The most common causative micro organism was the staphylococcus (7 out of 10 cases). The infected prosthetic valves were, in 8 out of the 10 cases, in the aortic position. The outcome was poor as the mortality rate was 60% (6 out of the 7 patients operated on in an emergency). Death was attributed to heart failure with conduction disturbances and severe aortic regurgitation (2 cases), cerebral emboli (2 cases), septicopyemia (2 cases). Four patients of the ten, after a mean follow up of 10 months, are cured without prosthetic valve dysfunction. The extreme gravity of prognosis seems related to the microorganism (staphylococcus), to the delay between the beginning of antibiotic therapy and the onset of the fever, and finally to the extension of destructive lesions under the prosthetic valve implantation base; the reimplantation of the prosthesis on frail and abscessed tissue implies a substantial risk of disinsertion. The indications for systematic early reoperation in cases of severe acute heart failure are discussed.