Nutrient intake and gastric cancer in Mexico.

In contrast to the decreasing trends observed in most countries, gastric-cancer mortality has remained at about the same level in Mexico throughout the last 40 years. As part of a study carried out in the metropolitan area of Mexico City, an assessment of nutrient intake and gastric cancer is presented here. The study population comprised 220 cases of gastric cancer and 752 population-based controls. Our results showed 70 to 80% reduction in the risk of developing this tumor, associated with the intake of polyunsaturated fat, fiber and vitamin E; and this effect was independent of the histological type of the tumor (i.e., intestinal or diffuse). On the other hand, an increased risk of gastric cancer was related to the consumption of saturated fat (OR(Q4vs.Q1) = 4.37, 95% CI 1.89-10.12) and, cholesterol (OR(Q4vs.Q1) = 2.39, 95% CI 1.23-4.64), but such effects were restricted to the intestinal type of gastric cancer. In the whole study population, mono-unsaturated fat intake increased the risk for gastric cancer, and a marginally significant increasing trend was observed for protein consumption. The findings from this study add information about the role of specific nutrients in the etiology of gastric cancer.     

Botulinum toxin type A treatment of hip and thigh spasticity: a technique for injection of psoas major muscle

Spasticity of the hip and thigh can result from spinal cord injury, multiple sclerosis, cerebral palsy and numerous other neurological conditions. Chronic hip spasticity causes the patient extreme difficulty in walking and maintaining a comfortable posture. First-line treatment usually consists of oral anti-spastic agents, although these are often associated with a high side-effect burden. intramuscular injections of botulinum toxin type A (BTX-A), particularly into the psoas major muscle, have proved to be of functional benefit to the patient. A highly reliable and reproducible method for injecting the psoas major muscle through a para-spinal route has been developed to reduce the power of the muscle and hip flexion deformity. Injection occurs through the middle of the erector spinae muscle at L2, L3 and L4, delivering a total of 150 U BTX-A to the psoas major muscle. Follow-up with a substantial rehabilitation programme reliably ensures a decrease in Modified Ashworth Scores and improvements in the outcome assessment scores measured.     

Lipid peroxidation in hepatic steatosis in humans is associated with hepatic fibrosis and occurs predominately in acinar zone 3

BACKGROUND AND AIMS: Hepatic steatosis has been shown to be associated with lipid peroxidation and hepatic fibrosis in a variety of liver diseases including non-alcoholic fatty liver disease. However, the lobular distribution of lipid peroxidation associated with hepatic steatosis, and the influence of hepatic iron stores on this are unknown. The aim of this study was to assess the distribution of lipid peroxidation in association with these factors, and the relationship of this to the fibrogenic cascade. METHODS: Liver biopsies from 39 patients with varying degrees of hepatic steatosis were assessed for evidence of lipid peroxidation (malondialdehyde adducts), hepatic iron, inflammation, fibrosis, hepatic stellate cell activation (alpha-smooth muscle actin and TGF-beta expression) and collagen type I synthesis (procollagen alpha1 (I) mRNA). RESULTS: Lipid peroxidation occurred in and adjacent to fat-laden hepatocytes and was maximal in acinar zone 3. Fibrosis was associated with steatosis (P < 0.04), lipid peroxidation (P < 0.05) and hepatic iron stores (P < 0.02). Multivariate logistic regression analysis confirmed the association between steatosis and lipid peroxidation within zone 3 hepatocytes (P < 0.05), while for hepatic iron, lipid peroxidation was seen within sinusoidal cells (P < 0.05), particularly in zone 1 (P < 0.02). Steatosis was also associated with acinar inflammation (P < 0.005). alpha-Smooth muscle actin expression was present in association with both lipid peroxidation and fibrosis. Although the effects of steatosis and iron on lipid peroxidation and fibrosis were additive, there was no evidence of a specific synergistic interaction between them. CONCLUSIONS: These observations support a model where steatosis exerts an effect on fibrosis through lipid peroxidation, particularly in zone 3 hepatocytes.     

Dietary factors and the risk of gastric cancer in Mexico City.

Dietary factors play an important role in gastric cancer risk but have not been investigated extensively in Mexico. The authors conducted a population-based case-control study of gastric cancer in the Mexico City, Mexico, metropolitan area in 1989-1990. A total of 220 patients with histologically confirmed gastric adenocarcinomas were interviewed. Controls were an age-stratified random sample of residents of the Mexico City metropolitan area. The dietary questionnaire was a 70-item semiquantitative food frequency adapted for the Mexican diet. Odds ratios were calculated for quartiles of consumption of food groups and were adjusted for age, gender, calories, chili pepper intake, cigarette smoking, socioeconomic status, added salt, and history of peptic ulcer disease. There was approximately a threefold increased risk of gastric cancer for frequent consumption (highest quartile) of both fresh meat (odds ratio (OR) = 3.1) and processed meat (OR = 3.2). Odds ratios were also significantly elevated for frequent consumption of dairy products (OR = 2.7) and fish (OR = 2.2). The authors observed a decreasing gradient of risk with increasing frequency of vegetable consumption due to a significant inverse trend for the yellow and orange vegetables. High intake of citrus fruits showed a slight inverse association. Consumption of salty snacks more than twice per month was associated with an 80 percent increased risk, and there was a significant positive trend. These findings are consistent with many studies around the world that indicate important roles for salt, processed meats, and vegetable consumption in gastric cancer risk.     

Intramuscular opioids for maternal pain relief in labour: a randomised controlled trial comparing pethidine with diamorphine

Objective To compare the pain relief and side effects of intramuscular pethidine with intramuscular diamorphine in labour.
Design Double-blind randomised controlled trial.
Setting The labour ward in a UK teaching hospital.
Participants Sixty-nine nulliparous women and 64 multiparous women in labour who requested narcotic analgesia and remained undelivered one hour after trial entry.
Methods Nulliparous women were randomised to receive either 150 mg intramuscular pethidine or 7–5 mg intramuscular diamorphine. Multiparous women were randomised to receive either 100 mg intramuscular pethidine or 5 mg intramuscular diamorphine. All participants received the anti-emetic prochloroperazine at the same time as the trial drugs.
Main outcome measures Maternal analgesia assessed by a visual analogue score and verbal scales of pain intensity and pain relief, maternal sedation and vomiting, neonatal outcome assessed by Apgar scores and the need for resuscitation.
Results More women allocated to receiving pethidine than to diamorphine reported slight or no pain relief at 60 minutes after administration of these drugs (   P = 0.03  ). This trend was repeated in most of the other measures for maternal analgesia. There was no difference in maternal sedation, but the incidence of vomiting within 60 minutes was lower for women who received diamorphine (   P = 0.02  ). Pethidine was associated with lower Apgar scores at 1 minute (   P < 0.05  ).
Conclusion Intramuscular diamorphine in labour appears to have some benefits, compared with intramuscular pethidine, but the trial was small and further research, particularly into alternative opioids and long term effects on the infants is still needed.