New screening method for lung cancer by detecting volatile organic compounds in breath

Lung cancer is a frequent cause of cancer-related deaths in the world. There is no valid screening process and this limits its detection to the late stages, with consequently high mortality rates. Volatile organic compounds (VOC) are chemical compounds (mainly the products of cell catabolism) found as gases in the human breath. Different methods have been developed to analyse VOCs and to compare them in healthy subjects and lung cancer patients. In this review, we summarise the different techniques used to analyse VOC. Many reports have been published with promising results similar to those achieved with accepted screening methods such as mammography. These methods show good perspectives on lung cancer screening. Supported by an unrestricted educational grant from Roche Farma S.A.     

Intraductal papillary-mucinous tumors: an entity which is infrequent and difficult to diagnose

BACKGROUND/AIMS: Intraductal papillary-mucinous tumor of the pancreas is currently considered to be a tumor which is an entity of its own, different from classic pancreatic ductal carcinoma. It is basically characterized by slow growth and low malignancy potential, as well as by the production of mucin. The aim of this study is to contribute to world literature some clarification of its natural history, clinical presentation, the most useful diagnostic tests, methods of detection of stromal invasion and handling of treatment. METHODOLOGY: Of 297 pancreatectomies undertaken at the "12 de Octubre" hospital between May 1985 and January 1998, only 1 case of Intraductal papillary-mucinous tumor was found. We have revised 127 cases published in 10 series over the last 10 years. We also contribute a review of our own case. RESULTS: These tumors, which are very infrequent, produce non-specific symptoms, with long latency periods from the first symptom up to stromal invasion. Endoscopic retrograde cholangiopancreatography showed alterations in 100% of cases where this was undertaken. Tumor-related mortality was zero amongst patients with non-invasive tumor who underwent surgery. None of the cases published presented upper gastrointestinal hemorrhage. This indicated the correct surgery and led us to our diagnosis. CONCLUSIONS: We confirm the low frequency and difficulty of diagnosis, the sensitivity of endoscopic retrograde cholangiopancreatography, the difficulty of early detection of stromal invasion, and the high survival rate in cases where resection is done before this occurs. Early diagnosis and treatment is therefore of utmost importance.     

Vitamin K status in cystic fibrosis

Appearance of PIVKA-II (protein induced by vitamin K absence-II) in serum is a biochemical sign of insufficient vitamin K-dependent carboxylation of prothrombin. Plasma concentrations of PIVKA-II and vitamin K1 were determined in 24 children with cystic fibrosis. Eight were supplemented with vitamin K1. The purpose of the study was to determine the occurrence of vitamin K deficiency in cystic fibrosis and to evaluate the effect of vitamin K supplementation. PIVKA-II was detectable in only one unsupplemented child. In this patient, the concentration of vitamin K1 was below the limit of detection of 60 ng/l. Vitamin K1 levels in the other unsupplemented children were normal (mean 476 ng/l = 1 mmol/l). The supplemented patients showed extremely high levels of vitamin K1 (mean 22445 ng/l = 50 nmol/l). In conclusion, vitamin K deficiency occurs infrequently in cystic fibrosis. Checking the coagulation system is advised, but routine vitamin K supplementation is not recommended. If additional vitamin K is needed, the starting dose should not exceed 1 mg daily.     

Semiquantitative culture of subcutaneous segment for conservative diagnosis of intravascular catheter-related infection

BACKGROUND: Sensitivity and negative predictive values of combined surface cultures (skin and hub) are high in the presumptive diagnosis of catheter-related infection, but specificity and PPVs are poor. The purpose of the study was to evaluate the yield of the semiquantitative culture of the subcutaneous segment in the diagnosis of colonization of the catheter tip without removal of the catheter. METHODS: A prospective study was performed in 124 nontunneled central venous catheters that were removed because of suspected infection or the end of therapy. Catheter colonization was considered if >15 colony-forming units (CFU) in the roll procedure or > 1,000 CFU in the quantitative Cleri procedure were recovered from the tip cultures ("gold standard"). Before removing the catheter, a semiquantitative culture of skin surrounding the point of insertion, a semiquantitative culture of the subcutaneous segment (after removing the catheter only 2 cm), a semiquantitative cultures of the hub, and a pareated quantitative blood culture were performed. Receiver operating characteristic curves were calculated to estimate the cutoff points, and a culture was considered positive when CFUs were > or =15, > or =15, and > or =5 for skin, hub, and subcutaneous segment cultures, respectively. RESULTS: Catheter colonization was detected in 51 catheters. The mean duration of catheterization was 14 +/- 8 days, and the rates of incidence of tip colonization and bacteremia were 2.9 per 100 catheter days and 1.2 per 100 catheter days, respectively. Sensitivity of skin, subcutaneous, and hub cultures analyzed individually were < or =61%; however, specificity and positive predictive values (PPVs) of subcutaneous segment cultures were significantly higher than skin cultures (94% and 88.5% vs 71.6% (p = .001) and 62% (p = .014), respectively). Sensitivity of the combined skin and hub cultures and of the combined subcutaneous segment and hub cultures were similar: 86.2% and 84.3%, respectively; however, specificity and PPVs of this latter combination were significantly higher than former: 82% and 78.1% vs 59.7% (p = .008) and 61.9% (p = .07), respectively. The likelihood ratio of a positive test for the combined subcutaneous segment and hub culture was 4.68, and only 2.13 for the combined skin and hub culture. CONCLUSIONS: These results indicate that the combined subcutaneous segment and hub culture constitutes an easy, effective procedure for the conservative diagnosis of catheter colonization.     

Predicting factors for admission to an intensive care unit and clinical outcome in pediatric patients receiving hematopoietic stem cell transplantation

BACKGROUND AND OBJECTIVES. In children, hematopoietic stem cell transplantation (HSCT) implies life-threatening complications and some patients need admission to a pediatric intensive care unit (PICU). Few studies have been reported analyzing this issue in a pediatric population and most focused on risk factors predicting survival following PICU admission. DESIGN AND METHODS. We examined data of 240 pediatric patients who received HSCT (100 allogeneic and 140 autologous) in order to ascertain the incidence of life-threatening complications requiring PICU admission, the contributing risk factors and the patients' long-term survival. RESULTS. Forty-two (17.5%) (25 males and 17 females) of the transplanted children were admitted to the PICU. Twenty-nine of them (69%) had received an allogeneic transplant and thirteen (31%) an autologous transplant. Their median age was 7 years (range; 1-18). The most frequent reason for admission was respiratory failure (37 cases, 88%). The overall probability of developing complications requiring PICU admission was 21.2% (33.5% for allogeneic transplantation and 10.1% for patients receiving autologous grafts, p=0.0002). On univariate analysis, only the type of transplantation was significantly associated with PICU admission (allogeneic vs autologous RR 1.92, 95% CI: 1.46-2.53)(p = 0.0001). In allogeneic transplants, only the underlying disease (non-malignant) and the status of disease at transplantation within malignant diseases (advanced phase) were pretransplant variables associated with PICU admission. Post-transplantation risk factors were presence of graft-versus-host disease (GvHD) (p = 0.046) and its grade (II-IV) (p = 0.002), as well as the presence of multiorgan dysfunction during the early post-infusion phase especially when the lung was the first failing organ (p = 0.0001). However, on multivariate analysis, only severe GvHD was statistically significant. In the autologous transplantation group, the underlying disease (solid tumor, p = 0.07) and status at transplantation (advanced phase, p = 0.0029) were the only risk factors. In the post-transplant phase, patients who develop multiorgan dysfunction during the neutropenic period and those with engraftment syndrome had an increased risk of requiring critical care. The overall event-free survival (EFS) at 3 years was 15.3%, (18.4% for autologous transplant recipients and 13.7% for those receiving an allogeneic graft, p = 0.4). Using a Cox regression model, multiorgan failure (MOF) present at admission was the only variable that had a negative impact on EFS (4.28% vs 35.71% for patients with no MOF, p = 0.016). INTERPRETATION AND CONCLUSIONS. Despite high mortality, intensive care support can be beneficial for pediatric patients with life-threatening complications following HSCT. However, for patients with multiorgan failure involving the lungs, admission to the PICU should be avoided.     

Nefazodone alters NPY immunostaining in rat arcuate-paraventricular projection without changes in food intake and body weight

Nefazodone is an antidepressant drug that inhibits serotonin and noradrenaline reuptake. The aim of the present work was to study the effects of nefazodone on food intake, body weight, adiposity and hypothalamic NPY immunostaining in rats. For this purpose, male Sprague-Dawley rats (3-month-old) were administered with nefazodone (20 mg/kg; i.p) daily for two weeks. The control group was given 0.9% NaCl solution. Hypothalamic arcuate, paraventricular, periventricular, supraoptic and suprachiasmatic nuclei and the lateral hypothalamic area were immunostained for NPY. Chronic nefazodone administration in rats did not modify food intake, body weight and adipose depot size (subcutaneous, perirenal and epididymal white adipose tissues, and interscapular brown adipose tissue). However, a significant decrease in paraventricular NPY immunostaining was found in the nefazodone group compared with the control group. No changes in other hypothalamic regions such as arcuate, periventricular, supraoptic and suprachiasmatic nuclei, and lateral and medial preoptic areas were observed. Because nefazodone is an alpha1-adrenoceptor antagonist, it can be proposed that the expected decrease in food intake after nefazodone administration, due to its effects on NPY arcuate-paraventricular projection, could be masked by the opposite orexigenic effect of alpha1-adrenoceptor blockade.     

Nutritional problems in nursing homes with special reference to Spain

In this review, after some short conceptual and demographical introductory remarks, I will focus my attention on four topics: a) The question of nutritional assessment of the elderly living in a nursing-home; b) Main nutritional disorders; c) Nursing-homes nutritional studies in Spain; and d) Guidelines and protocols.