Dietary sources of vitamin A, C, E and beta-carotene in a adult Mediterranean population

OBJECTIVE: Estimation of vitamin A, C, E and beta-carotene food sources, as well as its nutritional intake and density in adult Catalonian population. METHODOLOGY: A cross-sectional study was conducted over 2,346 individuals obtained from the sample of Catalonian Survey of Nutritional Status aged 18 to 75 years old to estimate usual dietary intake of vitamins A, C, E and beta-carotene using two 24 hour dietary recalls administered in two periods (june-july and november-december of 1992). Replicated 24 hour Recalls allowed for estimation of usual intake. Calculation of food sources for vitamins encompassed three phases: foods transformation into nutrients, aggregation of foods in categories and sum of nutrients by food categories. RESULTS: Intake of vitamin A (equivalents of retinol of provitamin A and vitamin A), E, C were closely near or higher than RDA. Nutritional density of vitamin C, E and beta-carotene were higher in female group. Nutritional density was positively associated to age for vitamins C, E and beta-carotene. Addition fat was the first source of vitamin E and it reached 33.8% of total vitamin E intake. Vegetables contributed in 17.3 % to the total vitamin C, whereas fruits accounted for 57.9%. Fruits recached 40.6% of the total beta-carotene intake, whereas vegetables accounted for 34.8%. The major contributors of vitamin A were milk and dairy products. CONCLUSIONS: Nutritional intake of vitamin A, C and E are over the RDA parameters suggesting an healthy nutritional status that must be confirmed and ratify by biochemical assessment. Nutritional densities were higher in female gender than in males in vitamins C, E, and beta-carotene possibly due to a higher intake of total lipids in male gender than in females. Nutritional density was positively associated to age in the same group of vitamins, suggesting a higher intake of empty calories in younger group. Fruits and Vegetables accounted for more than 70% of vitamin C and beta-carotene and major contributors were citrics, carrots, tomatoes, spinach, and cauliflower, highlighting their importance in elaboration of dietary guide lines.     

A New Method for Laparoscopic Access to the Space of Retzius During Retropubic Cystourethropexy

Purpose

We assessed the feasibility of a new technique for laparoscopic dissection of the space of Retzius.

Materials and Methods

In 10 women 40 to 70 years old (median age 45) undergoing laparoscopic retropubic cystourethropexy for stress urinary incontinence hydrodissection was used to create a pneumo-subperitoneal space. A suction irrigator probe was inserted into a mid peritoneal incision created with a 5 mm. trocar above the symphysis pubis between the 2 umbilical ligaments. The subperitoneal space was developed and insufflated with carbon dioxide without incising the peritoneum.

Results

All procedures were completed laparoscopically without intraoperative or postoperative complications. Operative time for cystourethropexy ranged from 30 to 70 minutes (median 40). Estimated blood loss ranged from less than 50 to 300 ml. (median 100). Patients were discharged from the hospital within 24 to 48 hours. All patients reported satisfactory relief of symptoms at 3 to 6 months of followup.

Conclusions

The new technique is not difficult and may minimize tissue injury. Pneumosubperitoneal pressure provides clear exposure of the space of Retzius with minimal bleeding.     

Joint task force "forward care" multicomponent health service support for an Army Reserve separate infantry brigade (mechanized)--Part III.

At the conclusion of 4 years' careful study of the health services support of a separate infantry brigade (mechanized) during the unit's annual training periods, the authors report on the effectiveness of a support team consisting of Army Reserve medical elements, an Active Army field unit, and a Public Health Service Clearing/Staging unit joining forces in a field environment to provide real world medical care to the same unit in a follow-on annual training period. The emphasis of the team created was on validating the forward care concept of field medical support. The result of this effort was "state of the art" medical service to the troops in the most forward areas, and a savings of 0.66 training days per soldier out of 10 days possible field training time. The cross-training of joint elements was enhanced by providing hands-on treatment of soldiers in a tactical environment, training that cannot be adequately replaced by simulated training.     

Immunomodulator properties of ecstasy (MDMA)

In vitro exposure to ecstasy (3,4-methylenedioxymethamphetamine, MDMA) alters some immune parameters such as T-cell regulatory function, cytotoxic T-lymphocyte activity, natural killer cell activity and macrophage function. Administration of MDMA in rats produces a suppression of lympho-proliferation response and a decrease in circulating lymphocytes, accompanied by an increase in plasma corticosterone. It was postulated a direct action of MDMA on lymphocytes or rather an indirect action mediated by the hypothalamic pituitary adrenal axis (HPA-AXIS) and/or the sympathetic nervous system (SNS). Acute MDMA treatment effected on healthy-volunteers produces an immune dysfunction associated with pharmaceutical characteristics and so with MDMA plasma concentrations. There is a decrease in CD4+ T-cells and functional responsiveness of lymphocytes, while percentage of natural killer cells increases. A contemporary rise of cortisol plasma concentrations supports the hypothesis of MDMA-induced release of corticotrophin-releasing factor from the hypothalamus and subsequent HPA-axis and SNS activation.     

New techniques in radical hysterectomy

PURPOSE OF REVIEW: To review the recent literature regarding modifications of abdominal radical hysterectomy as well as development of new approaches including laparoscopic, vaginal, and robotic radical hysterectomy. RECENT FINDINGS: Nerve-sparing radical hysterectomy technique allows for significant reduction in postoperative bladder morbidity. Radical vaginal hysterectomy with laparoscopic lymph node dissection is a well-recognized technique that offers excellent cure rates with absence of abdominal entry as well as reduced postoperative febrile and gastrointestinal morbidity. Total laparoscopic radical hysterectomy is a minimally invasive alternative to a traditional abdominal radical hysterectomy approach that yields comparable safety profile with a significant reduction in blood loss and hospital stay. Robotic surgery is becoming more widely accepted in the management of gynecologic cancers and larger series describing successful treatment of cervical cancer with robotic radical hysterectomy are soon to be published. SUMMARY: There are a number of approaches to performing radical hysterectomy. The feasibility and safety of these techniques have been well established. Preliminary oncologic outcome data are encouraging. The decision to utilize newer techniques depends on the patient and type of practice, as well as the surgeon's comfort level with laparoscopy, robotics, or vaginal surgery.     

Some Comments Regarding the Allergic State

Areas within which ragweed (Ambrosia) pollen concentrations equaled or exceeded selected values were determined from measurements around ten experimental ragweed sources. These areas were related to source size, surrounding vegetative cover, and meteorological conditions. Areas from 6 to 100 times the source area had mean concentrations above 100 grains/cu m while concentrations above 10 grains/cu m were found over areas from 11 to 300 times the source area. The size of the polluted area was related directly to source size and inversely to wind speed and the removal efficiency of surrounding vegetation.     

Tongue Cancer

This section is reserved for commentaries and brief essays dealing with matters of interest to physicians. Material for consideration should not exceed five double-spaced typewritten pages. An honorarium of $75 is offered at the time of publication. Submissions should be addressed to: Editor, POSTGRADUATE MEDICINE, 4630 W 77th St, Minneapolis, MN 55435.     

Postbiopsy renal transplant arteriovenous fistulas: color Doppler US characteristics

Color Doppler ultrasound (US) with point-spectral analysis was performed on eight patients with postbiopsy renal transplant arteriovenous fistulas. Waveform analysis of the supplying artery documented decreased resistive indices in all cases and increased flow velocities in seven. The peak-systolic flow velocity in the arteries supplying the fistulas ranged from 55 to 180 cm/sec (mean, 92 cm/sec), while the range in normal arteries was 20-52 cm/sec (mean, 32 cm/sec). The resistive indices of the arteries supplying the fistulas ranged from 0.31 to 0.50 (mean, 0.45), while the resistive indices of the normal arteries ranged from 0.60 to 0.92 (mean, 0.74). Arterialization of the venous waveform from the draining vein was also documented in all cases. In six cases, the increased flow velocities resulted in increased color saturation toward white in the supplying artery (n = 2) or in both the artery and the draining vein (n = 4), which was detectable on the realtime image. In six cases, flow turbulence resulted in localized tissue vibration, which appeared as random color assignment in extravascular renal parenchyma adjacent to the fistula. Knowledge of these imaging and Doppler characteristics should aid in the identification of renal transplant arteriovenous fistulas with color Doppler US.