Dietary glycemic index/load and peripheral adipokines and inflammatory markers in elderly subjects at high cardiovascular risk

Background and AimsEpidemiological and clinical studies suggest that low-glycemic index diets could protect against weight gain. However, the relationship between these diets and adipokines or inflammatory markers is unclear. In the present study we examine how the dietary glycemic index (GI) and dietary glycemic load (GL) are associated with several adipokines and related metabolic risk markers of obesity and diabetes in a cross-sectional and longitudinal manner.Methods and Results511 elderly community-dwelling men and women at high cardiovascular risk were recruited for the PREDIMED trial. Dietary data were collected at baseline and after 1 year of follow-up. The GI and GL were calculated. Plasma leptin, adiponectin and other metabolic risk markers were measured at baseline and after 1 year. At baseline, subjects in the highest quartiles of GI showed significantly higher levels of TNF and IL-6 than those in the lowest quartiles. Dietary GI index was negatively related to plasma leptin and adiponectin levels. After 1 year of follow-up, subjects with a higher increase in dietary GI or GL showed a greater reduction in leptin and adiponectin plasma levels. There was no association between GI or GL and the other metabolic markers measured.ConclusionOur results suggest that the consumption of high-GI or high-GL diets may modulate plasma concentrations of leptin and adiponectin, both adipostatic molecules implicated in energy balance and cardiometabolic risk.     

Abordaje laparoscópico en el tratamiento de las tumoraciones adrenales malignas

BackgroundMalignant primary or secondary adrenal tumours are uncommon. For most of them early surgery with adrenalectomy is the only means of cure. Although controversy exists on this issue, the increasing experience in laparoscopic surgery extends the indication for laparoscopic adrenalectomy to potentially malignant and to metastatic adrenal tumours. Our aim was to evaluate the technical feasibility of laparoscopic adrenalectomy for malignant neoplasias, describing the results of our consecutive series of patients.Material and methodsWe retrospectively analysed 13 patients who underwent laparoscopic adrenalectomy for malignant neoplasia between March 1999 and June 2009, at the Hospital de Clínicas of the Universidad of Buenos Aires and at the Hospital Alemán of Buenos Aires. A transperitoneal laparoscopic approach was used in all patients. The mean follow up was 37.9 months (2–84).ResultsThirteen laparoscopic adrenalectomies were performed due to malignant neoplasia. Mean age was 55.2+12 years. The relationship between male and female was 10/3. Five patients had an adrenal carcinoma, 1 patient a malignant phaeochromocytoma, and 7 patients had metastatic tumours. Three patients required conversion to laparotomy. Average operation time was 146.4 min. There were two perioperative complications and no mortality. Average length of hospital stay was 4.6 days (1–35). The survival at 3 years was 46%. The cause of death was the underlying disease in all cases.ConclusionLaparoscopic adrenalectomy is a reasonable technique for malignant adrenal tumours, when the open oncological resection can be reproduced by the laparoscopic approach.     

Gene polymorphism profiles of drug-metabolising enzymes GSTM1, GSTT1 and GSTP1 in an Argentinian population

Background: Glutathione S-transferases (GSTs) are drug-metabolising enzymes involved in biotransformation of carcinogens, drugs, xenobiotics and oxygen free radicals. Polymorphisms of GST genes contribute to inter-individual and population variability in the susceptibility to environmental risk factors, cancer predisposition and pharmacotherapy responses. However, data about GST variability in Argentina are lacking.

Aim: The purpose was to determine the prevalence of GSTM1, GSTT1 and GSTP1 polymorphisms in the general population from a central region of Argentina and to perform inter-population comparisons.

Subjects and methods: GSTM1 and GSTT1 gene deletions and GSTP1 c.313A?>?G were genotyped by PCR assays in 609 healthy and unrelated Argentinians.

Results: The frequencies of variant genotypes in Argentinians were GSTM1-null (45%), GSTT1-null (17%) and GSTP1-GG (11%). GSTM1-present genotype was significantly associated with GSTP1-AG or GSTP1-GG variants (p?=?0.037; p?=?0.034, respectively). Comparison with worldwide populations demonstrated that the GST distributions in Argentina are similar to those reported for Italy and Spain, whereas significant differences were observed regarding Asian and African populations (p?Conclusion: This study has determined, for the first time, the normative profile of three pharmacogenetically relevant polymorphisms (GSTM1, GSTT1 and GSTP1) in the largest Argentinian cohort described to date, providing the basis for further epidemiological and pharmacogenetic studies in this country.     

Fatal pneumonitis induced by oxaliplatin

Oxaliplatin has been approved for adjuvant treatment of colorectal cancer. Toxicity induced by oxaliplatin is moderate and manageable, but some isolated cases of severe pulmonary toxicity associated to oxaliplatin have been reported. Two fatal cases of interstitial pneumonitis rapidly evolving to pulmonary fibrosis are reported here.     

Exactness of mortality statistics by external and natural causes of death with medico-legal intervention in Catalonia, 1996

OBJECTIVE: Deaths due to external and natural causes with forensic intervention require medical-legal autopsy. In order to be included in the mortality statistics the results are reported in the statistical document MNP52. The accuracy of cause of death depends on the characteristics of the document, the point at which it is completed (after the death or after the autopsy) and the person that completes it. The objective is to determine the accuracy of external and natural causes of death with forensic intervention, reported in the official statistical documents by a medical-legal autopsy report of these deaths occurred in Catalonia in 1996. METHODS: Two samplings were undertaken--one for natural causes and another for external causes--that were stratified by sex and judicial district. The information sources were the Mortality Register of Catalonia for the statistical documents and the criminal courts for the medical-legal autopsy, toxicological and pathological reports. We calculated the index of agreement, the sensitivity or detection rate (DR) and the positive predictive value of confirmation rate (CR), and their respective 95% confidence intervals. RESULTS: The index of agreement was 72.3% (IC 95%: 68.7-75.9). The DR for external causes groups was 65.9% (60.6-71.2) and the CR was 69% (63.6-71.2). For natural causes the DR was 79.4% (74.7-84.2) and the CR was 75.5% (70.7-80.5). CONCLUSION: In deaths with forensic intervention, the official statistical documents do not correctly report external causes of death, and statistics for natural causes of death approach acceptable levels of accuracy. The results are mainly due to deficits in reporting and certifying these causes in the official statistics.     

Epidural abscess and regional anesthesia

An epidural abscess is a rare lesion whose consequences can cause high morbi-mortality, particularly in obstetrics, where it occurs in young, healthy patients. With increased use of regional anesthesia, the incidence of epidural abscess will increase. We therefore review the risk factors, most common etiology and clinical signs, which may be non-specific but are nevertheless suggestive. We also review available diagnostic methods. It may be difficult to distinguish epidural abscess from other causes of medullar compression, but prompt diagnosis is essential so that emergency surgical repair can proceed and neurological recovery will be as early and complete as possible. Appropriate antibiotic therapy should be aggressive. Basic aseptic measures are critical for preventing infection through epidural needles, as the presence of infection at the moment of puncture facilitates greater susceptibility to epidural abscess.     

Differential secretion of chicken growth hormone variants after growth hormone-releasing hormone stimulation in vitro

Variants of growth hormone (GH) are present in most vertebrates. Chicken GH (cGH) undergoes posttranslational modifications that contribute to its structural diversity. Although the 22-kDa form of GH is the most abundant, some other variants have discrete bioactivities that may not be shared by others. The proportion of cGH variants changes during ontogeny, suggesting that they are regulated differentially. The effect of growth hormone-releasing hormone (GHRH) on the release of cGH variants was studied in both pituitary gland and primary cell cultures, employing sodium dodecyl sulfate polyacrylamide gel electrophoresis, Western blotting, and densitometry. GHRH (2 nM, 2 h) stimulated the secretion of most of the size variants of cGH although the amplitude of increase was not equal for each one. A differential effect on the secretion of GH size variants, particularly on the 22- (monomer) and 26-kDa (putatively glycosylated) cGH isoforms was found in both systems. In the whole pituitary culture, the proportion of the 26-kDa immunoreactive cGH increased 35% while the 22 kDa decreased 31% after GHRH treatment in comparison with the controls. In the primary cell culture system, the proportion of the glycosylated variant increased 43% whereas the monomer and the dimer decreased 22.26 and 29%, respectively, after GHRH stimulation. Activators of intracellular signals such as 1 mM 8-bromo-cAMP and 1 μM phorbol myristate acetate had a similar effect to that obtained with GHRH. The data support the hypothesis that GH variants may be under differential control and that GHRH promotes the release of a glycosylated cGH variant that has an extended half-life in circulation.