Synovial Sarcoma Isn’t Supposed to To This!

Introduction/Objective

NA.

Methods/Case Report

A 35 year old male construction worker with no significant medical history presented with left posterior knee pain, weakness and numbness. Onset of symptoms coincided with an acute gout attack three months prior. Imaging revealed a 6.3 x 6.4 x 6.2 cm intraarticular, multicystic mass arising from the anterior cruciate ligament and extending posteriorly to displace the popliteal artery and vein. It was heterogenous, partially enhancing and aggressive appearing with associated bone erosion of the femoral condyle. Needle core biopsy showed a biphasic synovial sarcoma (SS), confirmed by SS18 gene rearrangement by fluorescence in situ hybridization. The patient underwent an above the knee amputation. Histologic examination of the resected tumor revealed a heterogenous histology. There were areas characteristic of a biphasic SS, hyperchromatic spindle cells, intermixed epithelial clusters and calcifications, and solid areas of round cells with necrosis and staghorn vessels, consistent with poorly differentiated SS. Additionally, a third histologic appearance with large pleomorphic tumor cells, markedly atypical mitotic figures and what appears to be matrix production was noted. These latter findings are not well described in SS but is suggestive of dedifferentiation. Next generation sequencing was performed, focused on the dedifferentiated appearing area, which confirmed the presence of SS18-SSX1 fusion. Additional findings included PDGFRA amplification and p53 mutation. We present this interesting case in order to demonstrate a previously undescribed variant of synovial sarcoma which could be a potential pitfall, especially had this been the area initially sampled in the biopsy.

Results (if a Case Study enter NA)

NA.

Conclusion

NA.

AB1467 EPIDEMIOLOGICAL DESCRIPTION OF JUVENILE IDIOPATHIC ARTHRITIS FROM A COLOMBIAN POPULATION

Background

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood and presents predominantly with peripheral arthritis; this pathology is divided into subgroups. In Colombia there are few descriptive studies.

Objectives

The objective was to describe the sociodemographic, immunological and clinical characteristics of a cohort of patients with Juvenile Idiopathic Arthritis.

Methods

An observational cross-sectional study was conducted that included 171 JIA patients treated at a specialized rheumatology institution between 2010 and 2021. Univariate analyzes were performed to describe the sociodemographic, immunological, and clinical profile of the population. The epidemiological characteristics were obtained from the review of medical reports.

Results

171 patients were analyzed. 58.48% were women; with a median age at diagnosis of 12.25 years (IQR=6.55), and a median duration of the disease of 3.71 years (IQR=5.52). According to the classification criteria of the International League of Associations for Rheumatism (ILAR), the most frequent were enthesitis related to JIA present in 61 patients (35.67%), oligoarticular 27 (15.79%), negative polyarticular rheumatoid factor (14.62%) and positive polyarticular rheumatoid factor (14.04%).

JIA-enthesitis related was 17,85% ANAs positive, 16,66% rheumatoid factor positive and HLA-B27 en 22,72%. In JIA oligoarticular the auto-antibodies ANAS, FR was present in 26,32% and 16,66%.

The JIA-polyarticular rheumatoid factor positive was positive for ANA in 76.47% and AntiCCP in 88.88%. JIA-polyarticular rheumatoid factor negative was positive for ANAs (40%) and AntiCCP (10%).

Conclusion

The epidemiological description of JIA in the Colombian population is similar to the current one in other populations, but we found differences in the subtypes of juvenile idiopathic arthritis and in the presence of autoantibodies. This is the first step to discover the characteristics of this autoimmune disease in this population.

Disclosure of Interests

Miguel Dario Canola Escobar: None declared, DANIEL RODRIGUEZ-ARIZA: None declared, LUIS AARON-INFANTE: None declared, DIANA CARDONA: None declared, YADITH HERNANDEZ-ARENAS: None declared, DIEGO MELO: None declared, JUAN PUENTES: None declared, PAULA ROZO-TELLEZ: None declared, Veronica Usuga-Graciano: None declared, OLGA ARIZA-QUINTERO Employee of: actual employee in Novartis Colombia as medical science liaison

Probiotics as a therapeutic strategy in obesity and overweight: a systematic review

Obesity and overweight are two of the most health challenges with an increasing prevalence in recent years, in which several complications have been identified to have a high impact in patients' health conditions. In this vein, an increasing interest in the gut microbiota has emerged as a target for therapeutic strategies in obesity and overweight due to its direct relation with the aforementioned health conditions and complications. Thus, the aim of this study was to evaluate the efficacy of probiotics as a therapeutic strategy in the management of obesity and overweight. A systematic review of randomised controlled trials was carried out in 6 databases until May 2019 to assess the use of probiotics in obesity and overweight patients. The Jadad Scale was used to assess the quality of the clinical trials. Twenty-three clinical trials published between 2000 and 2019 met the inclusion criteria. The role of probiotics in reducing body mass index and weight as well as changing the visceral abdominal fat area, waist and hip circumference were shown in 14 of 23 trials (60.87%); 14 trials (60.87%) showed changes on patients' fatty acids and biomarkers; and 4 trials (17.39%) studied the role of the gut microbiota in obese and overweight patients. Some probiotics strains are shown to be effective in reducing body mass index and hip circumference. This review provides evidence of successful results in weight loss using probiotic groups.

Are probiotic treatments useful on fibromyalgia syndrome or chronic fatigue syndrome patients? A systematic review

Evidence suggests that the gut microbiota might play an important role in fibromyalgia syndrome (FMS) and chronic fatigue syndrome (CFS). Our goal is to systematically review the reported effect of probiotic treatments in patients diagnosed with FMS or CFS. A systematic review was carried out using 14 databases (PubMed, Cochrane Library, Scopus, PsycINFO, and others) in February 2016 to search for randomised controlled trials (RCTs) and pilot studies of CFS or FMS patient, published in the last ten years (from 2006 to 2016). The Jadad scale was used to asseverate the quality of the clinical trials considered. Two studies (n=83) met the inclusion criteria, which were performed in CFS patients and both studies were considered as a 'High range of quality score'. The administration of Lactobacillus casei strain Shirota in CFS patients, over the course of 8 weeks, reduced anxiety scores. Likewise, this probiotic changed the faecal composition following 8 weeks of treatment. Additionally, the treatment with Bifidobacterium infantis 35624 in CFS patients, during the same period, reduced inflammatory biomarkers. The evidence about the usefulness of probiotics in CFS and FMS patients remains limited. The studied strains of probiotics have demonstrated a significant effect on modulating the anxiety and inflammatory processes in CFS patients. However, more experimental research, focusing mainly on the symptoms of the pathologies studied, is needed.

[Viscosity changes in thickened water due to the addition of highly prescribed drugs in geriatrics]

INTRODUCTION

Dysphagia is a swallowing disorder with a high incidence in the geriatric patient related with an increased risk for undernutrition and pneumonia due to bronchial aspiration. In this condition, it is usual to add commercial thickeners in liquids, as well as the addition of drugs in this mixture to improve their administration. However, there are no studies regarding the possible change in viscosity produced by their addition.

OBJECTIVES

To assess the change in viscosity of water thickened with commercial products by adding the drugs frequently used in elderly patients.

METHODS

Samples of water mixed with the commercial thickener Resource (modified corn starch) or Nutilis (modified corn starch, maltodextrin, and gums: tara, xhantan, and guar) to achieve an intermediate consistence as "honey". The viscosity of these samples was measured as well as for similar samples to which one of the following drugs was added: galantamine, rivastigmin, ciprofloxacin, cholecalciferol, memantine, fosfomycin, calcium, and amoxicillin/clavulanic acid.

RESULTS

In the samples with Resource thickener we observed decreased viscosity by adding galantamine, memantine, fosfomycin or calcium, and increased viscosity with amoxicillin/clavulanic acid. The viscosity of the samples with Nutilis® decreased with galantamine, rivastigmine, amoxicillin/clavulanic acid, fosfomycin and calcium.

CONCLUSION

The viscosity of water with commercial thickeners may be affected by some drugs or their preservatives, which may influence the swallowing capability. It is recommended to perform further in vitro and in vivo studies in order to adjust these formulations if necessary.

Mechanisms of initiation and reversal of drug-seeking behavior induced by prenatal exposure to glucocorticoids

Stress and exposure to glucocorticoids (GC) during early life render individuals vulnerable to brain disorders by inducing structural and chemical alterations in specific neural substrates. Here we show that adult rats that had been exposed to in utero GCs (iuGC) display increased preference for opiates and ethanol, and are more responsive to the psychostimulatory actions of morphine. These animals presented prominent changes in the nucleus accumbens (NAcc), a key component of the mesolimbic reward circuitry; specifically, cell numbers and dopamine (DA) levels were significantly reduced, whereas DA receptor 2 (Drd2) mRNA expression levels were markedly upregulated in the NAcc. Interestingly, repeated morphine exposure significantly downregulated Drd2 expression in iuGC-exposed animals, in parallel with increased DNA methylation of the Drd2 gene. Administration of a therapeutic dose of L-dopa reverted the hypodopaminergic state in the NAcc of iuGC animals, normalized Drd2 expression and prevented morphine-induced hypermethylation of the Drd2 promoter. In addition, L-dopa treatment promoted dendritic and synaptic plasticity in the NAcc and, importantly, reversed drug-seeking behavior. These results reveal a new mechanism through which drug-seeking behaviors may emerge and suggest that a brief and simple pharmacological intervention can restrain these behaviors in vulnerable individuals.

[Home Parenteral Nutrition (HPN) registry in Spain for the years 2007, 2008 and 2009 (NADYA-SENPE Group)]

OBJECTIVE

To report the data of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group for the years 2007, 2008 and 2009.

METHODOLOGY

We compiled the data from the on-line registry introduced by the responsible Units for the monitoring of HPN from January 1st 2007 to December 31st 2009. Included fields were: age, sex, diagnosis and reason for HPN, access path, complications, beginning and end dates, complementary oral or enteral nutrition, activity level, autonomy degree, product and fungible material supply, withdrawal reason and intestinal transplant indication.

RESULTS

2007: 133 patients with HPN were registered (61 males and 72 females), belonging to 21 hospitals. Average age for the 119 patients older than 13 years old was 53.7 ± 14.9 years, and 3.6 ± 3.6 y. for the 14 patients under 14 years old. Most frequent pathology was neoplasm (24%), followed by intestinal motility disorders and actinic enteritis (14% both). The reason for HPN provision was short bowel syndrome (43%), malabsorption (27%), and intestinal obstruction (23%). Tunnelled catheters were mostly used (69%), followed by implanted port-catheters (27%). Catheter related infections were the most frequent complications, with a rate of 0.92 episodes/103 HPN days. HPN was provided for more than two years in 50% of the cases. By the end of 2007, 71.4% of the patients remained active; exitus was the most frequent reason to end HPN (57.5%). 26% of the patients were eligible for intestinal transplant. 2008: 143 patients with HPN were registered (62 males and 81 females), belonging to 24 hospitals. Average age for the 133 patients older than 13 years old was 54.7 ± 13.9 years, and 3.7 ± 0.6 y. for the 10 patients under 14 years old. Most frequent pathology was neoplasm (20%), followed by actinic enteritis (14%) and intestinal motility disorders (13% ). The reason for HPN provision was short bowel syndrome (44%), malabsorption (28%), and intestinal obstruction (20%). Tunnelled catheters were mostly used (60%), followed by implanted port-catheters (29%). Catheter related infections were the most frequent complications, with a rate of 0.50 episodes/10³ HPN days. HPN was provided for more than two years in 67% of the cases. By the end of 2008, 71.6% of the patients remained active; exitus was the most frequent reason to end HPN (52.4%). 29% of the patients were eligible for intestinal transplant. 2009: 158 patients with HPN were registered (62 males and 96 females), belonging to 24 hospitals. Average age for the 149 patients older than 13 years old was 55.2 ± 13.0 years. Most frequent pathology was neoplasm (25%), followed by actinic enteritis (12%) and intestinal motility disorders (11%). The reason for HPN provision was short bowel syndrome (42%), malabsorption, and intestinal obstruction (23% both). Tunnelled catheters were mostly used (60%), followed by implanted port-catheters (36%). Catheter related infections were the most frequent complications, with a rate of 0.67 episodes/10³ HPN days. HPN was provided for more than two years in 58% of the cases. By the end of 2009, 79.2% of the patients remained active; full oral nutrition was the most frequent reason to end HPN (48%). 23% of the patients were eligible for intestinal transplant.

CONCLUSIONS

We observe an increase in registered patients with respect to previous years, with a very different prevalence among regions. Neoplasia remains as the main pathology since 2003. We observe a decrease in catheter-related infections in the last two years, being the 2008 rate the smallest since the register's beginning.

[Education on nutrition: from the university to specialized care]

The 7th Abbott-SENPE Forum is structured facing the new regulations of the European Space of High Education regarding the studies on Nutrition in the different degrees (Medicine, Pharmacology, Nutrition, Nursing) and post-doctoral education. A multi-professional and multidisciplinary discussion on the current situation of university education on nutrition, and its capabilities and limitations, is carried out. The value of the role of continuous medical education, the inhouse training programme, masters, and of scientific societies is also assessed. It is concluded that there is a need to urge academic authorities, the National Commission of Medical Specialties, the persons in charge of continuous medical education, and scientific societies of the importance of the studies relating to nutrition, feeding, and dietetics at both pre-graduate and post-graduate educational levels, and to implement and develop these studies in their areas of influence.

Impulsivity as long-term sequelae after chlorpyrifos intoxication: time course and individual differences

Chlorpyrifos (CPF) is a common organophosphate (OP) insecticide that has been widely used in agriculture as a pesticide. The primary mechanism of acute toxic action of OPs is initiated by acetylcholinesterase (AChE) inhibition. However, non-AChE targets have also been proposed as alternative that contributes to the acute lethal action and side effects of short or long-term exposure. Recently, we have found that a single dose of 250 mg/kg CPF produces acceleration in acquisition on schedule-induced polydipsia (SIP) procedure 6 months after its administration. Moreover, CPF animals show a higher level of impulsivity in a delay-discounting task 1 year after acute administration, and these effects are potentiated when animals are divided into high (HD) and low (LD) drinkers in SIP. In the present study, rats were injected with a subcutaneous (sc) dose of 250 mg/kg of CPF, and 10 weeks later its effect on delay-discounting task was evaluated. Consequently, these animals were evaluated based on SIP, and divided into two populations (HD and LD) according to their rates of drinking in this task. One year after OP administration, these animals were re-evaluated in a delay-discounting task. Results revealed that the CPF-administered rats prefer immediate reward and show a more impulsive choice, 10 weeks after CPF administration. Furthermore, 1 year after it administration, only animals treated with CPF that are high drinkers on SIP are more impulsive than the rest of the groups Therefore, these data suggest that some individuals are more sensitive to OP intoxication than the others, at least in terms of durability of sequelae.

Withanolides from Whitania aristata and their diuretic activity

AIM OF THE STUDY

Withania aristata is an endemic plant used traditionally in Canary Islands as a diuretic. In this paper, we report on this pharmacological activity in several extracts of the dry vegetal material collected and the identification and diuretic activity of two withanolides, one of them previously not reported, isolated from the most active fraction.

MATERIAL AND METHODS

Four Whitania aristata extracts at 100 mg/kg were orally administered to laboratory animals to evaluate their diuretic activity. From the most active fraction, two withanolides were isolated. Both and a mixture of them at 5 and 10 mg/kg were analyzed too as diuretics. Water excretion rate and content of Na(+) and K(+) electrolytes were measured in the urine of saline-loaded animals.

RESULTS

Whitania aristata water fraction, the two withanolides and the mixture of these compounds displayed high diuretic activity, with a significant excretion of sodium and potassium ions in laboratory animals.

CONCLUSIONS

This research supports the ethno-medicinal use of Whitania aristata as diuretic. This activity seems to be associated to the presence of a new type of natural diuretic agents, such as withaferin A and witharistatin.

[Registry of home-based enteral nutrition in Spain for the year 2006 (NADYA-SENPE Group)]

OBJECTIVE

To communicate the results obtained from the registry of Home-Based Enteral Nutrition (HBEN) of the NADYA-SENPE group for the year 2006.

MATERIAL AND METHODS

Recompilation of the data from the HBEN registry of the NADYA-SENPE group from January 1st to December 31st of 2006.

RESULTS

During the year 2006, 3,921 patients (51% men) from 27 hospital centers were registered. Ninety-seven percent were older than 14 years. The mean age for those < 14 years was 4.9 +/- 3.9 (m +/- SD) and in those > or = 14 years, it was 68.5 +/- 18.2 years. The most common underlying disease was neurological pathology (42%), followed by cancer (28%). Enteral nutrition was administered p.o. in 44% of the patients, through nasogastric tube in 40%, gastrostomy in 14%, and jejunostomy in 1%. The average time of nutritional support was 8.8 months. The most common reasons for ending the therapy were patient's death (54%) and switching to oral feeding (32%). Thirty-one percent of the patients presented a limited activity and 40% were confined to bed/coach. Most of the patients required partial (25%) or total (43%) care assistance. The nutritional formula was provided by the hospital in 62% of the cases and from the reference pharmacy in 27%. The fungible material was provided by the hospital in 80% of the cases and by primary care in the remaining patients.

CONCLUSIONS

Although the number of registered patients is slightly higher than that from the last years, there are no important changes in the patients characteristics, or way of administration and duration of enteral nutrition.

[Total enteral nutrition vs. total parenteral nutrition in patients with severe acute pancreatitis]

OBJECTIVE

To compare the efficacy of early total enteral nutrition (TEN) vs. total parenteral nutrition (TPN) in patients with severe acute pancreatitis (SAP).

METHODS

A total of 22 consecutive patients with SAP were randomized to receive TPN (group I) or TEN (group II). SAP was defined applying APACHE II score, C-reactive protein (CRP) measurements and/or Balthazar CT scan score. Acute inflammatory response (CRP, TNF-a, IL-6), visceral proteins (pre-albumin, albumin), complications (systemic inflammatory response syndrome, multiorgan failure, infections), surgical interventions, length of hospital stay and mortality were evaluated.

RESULTS

No significant differences were found between the two groups in the APACHE II score, in CRP, TNF-a and IL-6 concentrations or in pre-albumin and albumin levels over the first 10 days. Seven patients in group I and 4 in group II suffered severe complications. Three patients in group I required surgical intervention. Length of hospital stay was alike in the two groups. Two patients from group I died in the course of the hospitalization.

CONCLUSIONS

SAP patients with TEN feeding showed a tendency towards a better outcome than patients receiving TPN.

Vulnerability of long-term neurotoxicity of chlorpyrifos: effect on schedule-induced polydipsia and a delay discounting task

INTRODUCTION

Chlorpyrifos (CPF) is a common organophosphate (OP) insecticide that has been widely used in extensive agriculture as a pesticide. The primary mechanism of acute toxic action of OPs is inhibition of acetylcholinesterase (AChE). However, targets other than AChE have been proposed to contribute to the acute lethal action and side effects of short- or long-term exposure to these compounds. Bekkedal et al. (Sci Total Environ 274:119-123;2001) showed that chronic administration of the OP trimethylolpropane phosphate (TMPP) reduces the number of schedule-induced polydipsia (SIP) sessions necessary to induce asymptotic drinking level.

MATERIALS AND METHODS

In the present work, rats were injected with 250 mg/kg CPF and 6 months later, its effect on schedule-induced polydipsia was evaluated. In addition, after stable levels of SIP, a pharmacological study was carried out to determine the implication of other systems in the long-term effects of OPs. Finally, these animals were evaluated in a delay discounting task, as a measure of impulsivity.

RESULTS

Results indicate that the CPF group gives more licks to obtain the same amount of water than control rats (VHC). Moreover, the administration of diazepam produces an increased water intake in the CPF without any observable effect in VHC rats. Data of the delay discounting task show that CPF rats prefer an immediate reward and show a major impulsive choice.

DISCUSSION

Taken together, our data confirm and extend the long-term behavioral effects of subcutaneous administration of CPF and point to a role for other systems that, besides AChE inhibition, contribute to the long-term neurotoxicity of CPF.

[Pharmacological therapy of cancer anorexia-cachexia]

Anorexia is one of the most common symptoms of patients with advanced cancer and it presents as loss of appetite due to satiety. On the other hand, cachexia is described in those patients with unwanted weight loss. Cancerous processes produce an energy unbalance by decreased food intake and increased catabolism, resulting in a clearly negative balance. Several factors determining cachexia are observed, from metabolic unbalances produced by tumoral products and endocrine impairments or the inflammatory response produced by cytokines, all of them leading to higher lipolysis, loss of muscle protein, and anorexia. Besides, causes of anorexia are multiple, from chemotherapy agents, radiotherapy, or immunotherapy, which may produce different degrees of nausea, vomiting, diarrhea, and also leading to impairments of taste and smell, to obstruction of the digestive tract, pain, depression, constipation, etc. From the knowledge of the different mechanisms producing the anorexia-cachexia syndrome, hypercaloric diets for artificial nutrition have been studied with varying success, and different drugs with a positive effect on appetite gain such as progestogens, steroids, and with lesser clinical evidence cannabinoids, cyproheptadine, mirtazapine (antidepressant), and olanzapine (antipsychotic). Other drugs have been studied because of their anti-inflammatory properties, anti-cytokine, such as melatonin, polyunsaturated omega-3 fatty acids, pentoxifylline, and thalidomide; with the exception of the latter, clinical data are still scant for daily usage. Similarly happens with testosterone-derived anabolic drugs or with metabolism inhibitors such as hydrazine sulfate. With no doubt, progestogens, especially megestrol, and corticosteroids will be first-line therapies for anorexia-cachexia syndrome to stimulate the appetite and increase weight (megestrol), and have an effect on quality of life improvement and comfort in patients with advanced cancer.

[The year 2003 National Registry of Home-based Parenteral Nutrition]

OBJECTIVE

To report the results of the Home-based Parenteral Nutrition (HBPN) registry of the NADYA-SENPE working group, for the year 2003.

MATERIAL AND METHODS

Gathering of registry data introduced by all units responsible of HBPN patient care. This an on-line registry available for authorized users of the working group web page (www.nadya-senpe.com). Epidemiological data, diagnosis, access route, complications, hospital admissions, disability degree, and course at December 31st, 2003

RESULTS

Data from 86 patients (62% female and 38% male) from 17 hospitals were gathered. Mean age of adult patients was 50.7 +/- 15.0 years, whereas for patients younger than 14 years was 2.4 +/- 1.5 years (n = 5 patients). Diseases that prone HBPN were neoplasm (21%), followed by mesenteric ischemia (20%), radiation enteritis (16.3%), motility impairments (10.5%), and Crohn's disease (4.6%). Tunneled catheters were used in 66.3% of the cases versus 29.1% of subcutaneous reservoirs. Mean treatment duration has been 8.5 +/- 4.6 months; 67.4% of patients had been on HBPN for a period of time longer than 6 months. Patient follow-up was mostly done from the reference area hospital (88.4%). In no case patient follow-up was done by the primary care team or by specialists other than those prescribing nutritional support. Nutritional support-related complications were seen in 98 occasions. The most frequent complications were infectious ones. They represented 1.60 hospital admissions per patient. The mean number of visits was 7.9 per patient (6.4 for scheduled visits and 1.5 for emergency visits). By the end of the year, we observed that 73.3% of the patients were still on the program, whereas in 23.3% HBPN had been withdrawn. The main reasons for withdrawal were decease (11 patients), and advancing to oral diet (9 patients). As for the disability degree, 13% were confined to a wheelchair or bed, and only 28% had no disability degree or only mild social disability.

CONCLUSIONS

We observed a mild increase in HBPN prevalence rate in Spain (2.15 patients pmp). The main indication was cancer followed by short-bowel syndrome secondary to vascular pathology. Nutritional support-related complications were common, especially those of an infectious origin.

[National registry of Home Enteral Nutrition in 2003]

GOAL

To communicate the information available by the NADYA-SENPE Working Group from patients on Home Enteral Nutrition (HEN) in our country during the year 2003.

MATERIAL AND METHODS

The data were collected through a closed questionnaire included in the web site of the Working Group (www.nadya-senpe.com) available only by the authorized users. Variable included were: epidemiological information, the indication to prescribe this treatment, the access path, the specific nutritional formula used, the treatment duration, the complications and hospital readmission related to the nutritional treatment, the follow-up and the quality of life.

RESULTS

We register 3,858 patients that belong to twenty-one hospitals. Mean age from those adults 66.2 +/- 18.9 years, and from those younger than 14, 6.0 +/- 4.3 years. Neurological and neoplasic diseases were the diagnostics more frequents (38.9% and 37.4%, respectively). Oral nutrition was the preferential rout used for the enteral nutrition (54.7%) followed by naso-enteral tube (26.6%), and only in 17.6% we used ostomy tubes. Polymeric was the enteral formula mainly utilized (80.1%). The mean time on HEN was 6.6 +/- 4.3 months; the 28.8% of patients stayed in the treatment for less than 3 months, 21.2 % between 3 and 6 months, and 50.0% more than 6 months. Patients were followed mainly by Nutritional Support Unit from the reference hospital (73.1%). While the reference hospital supplies the material (62.4%), reference hospital pharmacy (46.8%) and public pharmacies (32.0%) provides the enteral formula. Complications related to enteral nutrition included change of enteral tube (44.5%), gastrointestinal complications (30.5%), mechanical complications (21.7%), and the metabolic one (3.3%). These complications were followed by 0.02 hospitalizations/patient. At the end of the year, 54.7% of patients were in the HEN programme, and in 35.2 % HEN was finish due to accept oral conventional alimentation (49.2%) or by deceased of patients (40.9%). While 26.6% of the patients were confined to bed or armchair, 19.7 % no or light discapacity degree was observed.

CONCLUSIONS

We found a persistence of these treatment in our country. Neurological and neoplasic diseases were the more frequent diagnosis in patients analysed. The high prevalence of cancer patients could be the main cause of oral access for enteral nutrition. Change of enteral tube was the more frequent complication observed during this treatment.

[The year 2002 national registry on home-based enteral nutrition]

GOAL

To communicate the information available by the NADYA-SENPE Working Group from patients on Home Enteral Nutrition (HEN) in our country during the year 2002.

MATERIAL AND METHODS

The data were collected through a closed questionnaire included in the web site of the Working Group (www.nadya-senpe.com) available only by the authorized users. Variable included were: epidemiological information, the indication to prescribe this treatment, the access path, the specific nutritional formula used, the treatment duration, the complications and hospital readmission related to the nutritional treatment, the follow-up and the quality of life.

RESULTS

We register 3967 patients that belong to twenty-one hospitals. Mean age from those adults 69.2 +/- 19.2 years, and from those younger than 14, 5.6 +/- 4.1 years. Neurological and neoplasic diseases were the diagnostics more frequents (39.2% and 34.6%, respectively). Oral nutrition was the preferential rout used for the enteral nutrition (53.6%) followed by naso-enteral tube (30.6%), and only in 15.8% we used ostomy tubes. Polymeric was the enteral formula mainly utilized (81.5%). The mean time on HEN was 5.8 +/- 4.4 months; the 35.7% of patients stayed in the treatment for less than 3 months, 22.4% between 3 and 6 months, and 41.6% more than 6 months. Patients were followed mainly by Nutritional Support Unit from the reference hospital (75.3%). While the reference hospital supplies the material (65.7%), reference hospital pharmacy (43%) and public pharmacies (37.3%) provides the enteral formula. Complications related to enteral nutrition included change of enteral tube (29.7%), mechanical complications (22.9%), gastrointestinal complications (22.9%), and the metabolic one (9.2%). These complications were followed by 0.02 hospitalizations/patient. At the end of the year, 49.3% of patients were in the HEN programme, and in 41.5% HEN was finish due to accept oral conventional alimentation (47.3%) or by deceased of patients. While 31.8% of the patients were confined to bed o armchair, 17.8% no o light discapacity degree was observed.

CONCLUSIONS

We found a persistence of these treatment in our country (96.5 patients/million inhabitants. Neurological and neoplasic diseases were the more frequent diagnosis in patients analysed. The high prevalence of cancer patients could be the main cause of oral access for enteral nutrition. Change of enteral tube was the more frequent complication observed during this treatment.

The importance of clinical factors in parenteral nutrition-associated hypertriglyceridemia

AIMS

The purpose of this study was to establish the relevance of several clinical factors associated with parenteral nutrition (PN) hypertriglyceridemia and to construct a predictive model for this complication.

METHOD

This multicenter study included all patients with initial serum triglyceridemia <3 mmol and receiving a minimum of 7 days' PN therapy. The study ended for each patient when hypertriglyceridemia developed or PN was terminated. Two multivariate models were constructed, one to study the clinical factors and the second to predict plasma triglyceridemia. A total of 22 clinical factors studied as independent variables were included in the multiple-step regression models only when they showed a P-value over 0.1. Statistical significance was determined by the confidence interval of the odds ratio (OR) and the partial regression coefficient (b).

RESULTS

The study included 260 patients from 14 hospitals. Lipid administration was 0.83+/-0.37 g/kg/day. Among the total, 68 patients (26.2%) showed hypertriglyceridemia. Variables included in both models were serum glucose (OR, 2.63; b, 0.06), renal failure (OR, 10.56; b, 1.70), corticoid administration >0.5 mg/kg (OR, 7.98; b, 0.97), pancreatitis (OR, 4.38; b, 0.64), sepsis (OR, 4.48; b, 0.24), lipids infused (OR, 3.03; b, 0.24) and heparin administration >3 mg/kg/day (OR, 0.11; b, -1.21).

CONCLUSION

Although the rate of lipid infusion was low, certain clinical factors modified triglyceridemia. Nevertheless, relatively fast plasma clearance of lipids infused indicates that a reduction in lipid supply could be a quick, effective measure for controlling hypertriglyceridemia. Thus, careful monitoring of patients with clinical factors predicting risk in the model studied, with adjustment of lipid perfusion rates accordingly, is suggested to avoid hypertriglyceridemia.

[Relation between the viscosity of enteral diets and mechanical complications in their administration according to the nasogastric catheters]

OBJECTIVE

The use of enteral nutrition has increased enormously over the last few years and at the same time the standard indications for parenteral nutrition, whether in hospitals or at home, have gradually been defined. The most common way to administer enteral nutrition is intermittently and using gravity, through a nasogastric catheter or through gastrostomy. In our daily practice it has been observed that there was at times a considerable delay in the administration of the diet by means of a nasogastric catheter and the tube was sometimes blocked due to its small calibre and/or the excessive viscosity of the formula. It was therefore proposed to study the viscosities of polymeric enteral diets with and without fibre at this hospital to identify the relationship with the time taken for their intermittent, gravity-driven administration through different calibres of nasogastric catheter at the maximum flow rate.

RESULTS

Some of the enteral diets under study exceeded the recommended time for intermittent administration by gravity (20-40 minutes).

CONCLUSIONS

We feel it is essential for the product label to provide information on the optimal calibre of the nasogastric catheter required for administration of the product.

Microbiological quality control study of "all-in-one" total parenteral nutrition admixtures

A microbiological quality control study of parenteral nutrition (PN) is presented. The study was carried out in the Pharmacy and Microbiology Services of the Hospital de la Santa Creu i Sant Pau (Barcelona, Spain) from April 1991 to May 1998 and represents more than 25,000 lipid-containing PN admixtures prepared during that 7-year period. A randomized sampling procedure according to the cumulative sum control charts was performed and a 0.45-microm membrane filtration method was used as the microbiological test. Validation showed that the method is sensitive for sterility tests. Bacterial growth was observed on 59 filters (4.58% of the samples). A second control was made for these positive outcomes, and bacterial growth was found in only two cases. The patients' clinical history was reviewed and no relation between the microorganisms of the nutrition and the results obtained from blood cultures was observed. The quality control study revealed a low incidence of contamination in our PN preparation process.

Application of microsatellite PCR techniques in the identification of mixed up tissue specimens in surgical pathology

A fragment of tumour was erroneously mixed up with an endometrial biopsy. Micro-satellite polymerase chain reaction (PCR) clearly demonstrated the extraneous nature of the fragment. Micro-satellite PCR may be useful for the identification of mis-labelled or mismatched tissue fragments in surgical pathology specimens.

1-(1,3-Benzothiazol-2-yl)-2-(2-bromo-5-nitrophenyl)ethanone

The title compound, C15H9BrN2O3S, was isolated as an unexpected product from the reaction of the anion of sodium 2-(1,3-benzothiazolyl)ethanonitrile with alpha,2-dibromo-5-nitrotoluene. Its structure features a benzothiazole fragment and a bromo- and nitro-substituted phenyl ring linked by a methyl ketone group. The dihedral angle between the benzothiazole and phenyl rings is 103.7 (2) degrees. The benzothiazole fragment is planar, with a maximum deviation of 0.021 (2) A. The nitro group is slightly rotated out of the phenyl-ring plane, with a O(2)-N(2)-C(14)-C(15) torsion angle of 16.4(7) degrees.

[Determination of nutritional parameters affected in patients with gastric adenocarcinoma who are candidates for surgery according to tumor stage]

An attempt is made to determine the nutritional parameters which are affected in patients with a gastric adeno-carcinoma, who are candidates for surgery, and to relate these parameters to the surgical technique employed, and to the tumor stage. Later, they aim to determine the parameters which may be indicative of the surgical prognosis of these patients. To this end, between January 1992 and October 1994, 66 patients, distributed in two groups, were studied. Group A included the patients who had undergone a total gastrectomy or a partial gastrectomy, and group B included those individuals subjected to an exploratory laparotomy, gastro-intestinal derivation, and subtotal or palliative gastrectomy. When analyzing the results obtained in the two groups of patients, it is observed that all of them have one or more altered nutritional parameters, and that the means of these parameters are more altered in group B than in group A. However, only the percentage of weight loss and the serum albumin level present significant differences between the two groups. That is to say, we observe that patients with serum albumin levels lower than 35 g/l, and with a weight loss of > 6%, have a greater risk of being subjected to an exploratory laparotomy, a gastro-intestinal derivation, or a total or subtotal palliative gastrectomy, than do patients with serum albumin levels > 35 g/l and a weight loss of < or = 6%. We may conclude that the loss of weight and the serum albumin level may help to decide a more or less aggressive surgical approach, and to predict the possible resectability of the tumor.

[Comparative study of two lipid emulsions in patients receiving total parenteral nutrition]

INTRODUCTION

the use of lipid emulsions together with glucose as a calorie source in parenteral nutrition has undisputed advantages. Their isotony and high calorie content mean they are essential for peripheric parenteral nutrition and in parenteral nutrition of long duration they are important in providing essential fatty acids.

OBJECTIVE

to determine the constant of elimination of two commercial lipid emulsions with similar compositions, and evaluate whether significant differences exist between them. MATERIAL, METHODS AND PATIENTS: 20 candidates for total parenteral nutrition were studied over a period of at least ten days. These patients showed no severe stress, sepsis or IRA. The patients received total parenteral nutrition for at least 3 days prior to commencing the study; 12 hours after initiation, total parenteral nutrition was administered, without lipids. Afterwards, one of the emulsions studied was infused centrally (in Y with the parenteral nutrition) at a rate of 0.15 g/kg/hour for 3 hours, 24 hours later, the other emulsion was infused under the same conditions. Commencing with one or the other was done at random, and both at 10%. Blood samples were taken at the following times:--10.0 (end of the infusion of the emulsion), 10, 30, 60 and 90 minutes, and the following parameters studied: total cholesterol (col), triglycerides (tg) and phospholipids (pl); tg, col ad pl of the VLDL, HDL and LDL, free fatty acids and lipoprotein lipase. The analytical methods employed were: ultracentrifugation with compressed air and precipitation with PEG-6000.

RESULTS

significant differences were observed in the constant of elimination of total tg (2.54 +/- 0.73 in emulsion A compared to 2.8 +/- 0.66 in B), in the Kd of the VLDL tg (1.65 +/- 0.86 in A compared to 1.99 +/- 0.77 in B) and in the Kd of the VLDL P1 (0.98 +/- 0.53 in the case of A compared to 1.1 +/- 0.43 in emulsion B), no significant differences were found in the other parameters studied. The Student T was applied, and no lipase lipoprotein activity was observed.

DISCUSSION

the differences found may perhaps be explained by the action of the emulgent on the intravascular metabolism of the fats. Although in both cases this is egg lecithin, the composition of this has not been studied in depth. Emulsion A = Intralipid (n. reg). Emulsion B = Tutolipid (n. reg.).

[Value of parenteral nutrition in total gastrectomy for cancer. A prospective study]

A prospective study is presented in which the impact of total parenteral nutrition (TNP) was analyzed in a group of 27 patients that underwent total gastrectomy due to gastric carcinoma (TGGC). Patients were randomly divided into two groups: Group I was formed by 15 patients and was treated systematically with TPN during the immediate postoperative period (POTPN). Group II was formed by 12 patients who were treated with conventional serum therapy during the immediate postoperative period. TPN was administered if enteral nutrition was not viable and/or patients presented complications. Both groups were similar regarding age, sex, previous illness, previous nutritional status (Preop PNI) and surgical technique used in GI transit reconstruction. Morbidity and mortality rates, nutritional status (PNI 5 days postop) and mean hospital stay were analyzed in both groups. Likewise, a retrospective comparison was made between the results obtained from this trial and those from a group of 44 patients with gastric carcinoma who underwent TGGC at our hospital a decade earlier and did not received TPN during the immediate postoperative period on a routine basis. When both series and Groups I and II were compared significant differences in mean hospital stay were observed in favor of Group I treated with routine TPN in the immediate postoperative period. There were no differences in the mortality rate when all groups were compared. It was concluded that TPN was useful in patients undergoing TGGC because it reduced postoperative mortality rate, decreased mean hospital stay and showed good cost/effectiveness correlation.

[Nutritional status and cephalic duodenopancreatectomy in neoplasm treatment]

Usually, nutritional status of patients with neoplasia is poor. This is an important factor when the radical resection of the tumor implies aggressive surgery, and it has a clear influence on postoperative morbidity and mortality. From 1979 to 1988, 33 cephalic duodenopancreatectomies for carcinoma of the ampullary region have been carried out in the Servicio de Cirugía Digestiva, hospital "Santa Cruz y San Pablo". For retrospective evaluation of postoperative parenteral nutrition patients have been divided in two groups: group A, with routine parenteral nutrition and group B, with parenteral nutrition only if required. In group A, 75% of patients did not present postoperative morbidity, compared to 38% of patients in group B. There were 7 deaths: all of them in group B. The time of hospitalization was lower in group A. Differences in the three parameters under consideration was statistically significant. We conclude that, in order to improve morbidity and mortality as well as to reduce the hospitalization time, postoperative parenteral nutrition is necessary in patients submitted to cephalic duodenopancreatectomy for neoplasia.

[In vitro stability of amikacin and ciprofloxacin administered through a Y-shaped catheter connection with 2 total parenteral nutrition formulations with different pH]

We studied the stability of amikacin and ciprofloxacin in in vitro coinfusion with two total parenteral nutrition. The antibiotic concentrations were determined by EMIT and HPLC for amikacin and ciprofloxacin, respectively. There were not significant differences between theoretical and measured concentrations. The emulsion stability were analyzed by visual inspection, Coulter-Counter and optic microscopy. The emulsion was stable and we didn't find any particle of size greater than 6 microns.

Systemic administration of MK-801 protects against N-methyl-D-aspartate- and quisqualate-mediated neurotoxicity in perinatal rats

MK-801, a non-competitive antagonist of N-methyl-D-aspartate-type glutamate receptors, was tested for its ability to antagonize excitotoxic actions of N-methyl-D-aspartate or quisqualic acid injected into the brains of seven-day-old rats. Stereotaxic injection of N-methyl-D-aspartate (25 nmol/0.5 microliters) or quisqualic acid (100 nmol/1.0 microliter) into the corpus striatum under ether anesthesia consistently produced severe unilateral neuronal necrosis in the basal ganglia, dorsal hippocampus and overlying neocortex. The distribution of the damage corresponded to the topography of glutamate receptors in the vulnerable regions demonstrated by previous autoradiographic studies. N-Methyl-D-aspartate produced severe, confluent neuronal destruction while quisqualic acid typically caused more selective neuronal necrosis. Intraperitoneal administration of MK-801 (0.1-1.0 mg/kg) 30 min before N-methyl-D-aspartate injection had a prominent dose-dependent neuroprotective effects as assessed morphometrically by comparison of bilateral striatal, hippocampal and cerebral hemisphere cross-sectional areas five days later. A 1 mg/kg dose of MK-801 given as pre-treatment completely protected the infant brain. The same dose of MK-801 was also completely protective when administered 30 or 40 min after N-methyl-D-aspartate and afforded partial protection when given 2 h later. MK-801 pre-treatment also prevented the electrically confirmed behavioral seizures induced by N-methyl-D-aspartate. The drug significantly reduced striatal but not hippocampal or neocortical injury when given as two doses (1 mg/kg) 30 min prior to and immediately following quisqualic acid injection. The data indicate that systemic administration of MK-801 can prevent N-methyl-D-aspartate-induced neuronal injury in perinatal rat brain even when administered after the initial insult. MK-801 also partially antagonized quisqualic acid-mediated neurotoxicity, suggesting that quisqualic acid-induced toxicity is, in part, mediated through N-methyl-D-aspartate receptor activation. The sensitivity of the developing brain to the toxicity of N-methyl-D-aspartate provides a sensitive and reproducible in vivo model for exploring these issues and for screening prospective neuroprotective drugs that act at the N-methyl-D-aspartate receptor-channel complex.

[Effect of peripheral parenteral nutrition on the immediate postoperative period in surgery of the aortic sector]

There is not an extensive literature about nutritional value in Vascular Surgery. In this study, efficacy and cost/benefit relation in the application of Peripheric Parenteral Nutrition (PPN) in postoperative of aortic surgery, are investigated through two randomized groups, in patients with aortoiliac obstructive arteriopathy and who needed an aortobifemoral bypass.