Weight regain after slimming induced by an energy-restricted diet depends on interleukin-6 and peroxisome-proliferator-activated-receptor-gamma2 gene polymorphisms

Weight-loss maintenance after following an energy-restricted diet is a major problem that a number of studies are trying to characterise. The aim of the present study was to investigate the role of IL-6 -174G>C and PPAR-gamma2 Pro12Ala variants on weight regulation in obese subjects receiving a low-energy diet and at 1 year after the acute slimming period. Sixty-seven volunteers (age 34.7 (SD 7.0) years; BMI 35.8 (SD 4.8) kg/m(2)) were enrolled in a 10-week dietary intervention and were contacted again 1 year after the end of this period. Body composition was measured at three times during the study. Also, PPAR-gamma2 Pro12Ala and IL-6 -174G>C polymorphisms were analysed in the participants. No statistical differences were observed depending on the genetic variants at baseline for anthropometric variables, or after the intervention. However, the C allele of the -174G>C IL-6 gene polymorphism was more frequently observed (P=0.032) in subjects with successful weight maintenance (<10 % weight regain). In fact, the C allele partially protected against weight regain (odds ratio 0.24; P=0.049), while the conjoint presence of both gene variants (C+ and Ala+) further improved the ability for weight maintenance (odds ratio 0.19; P=0.043). The present study demonstrates that the C allele of the -174G>C polymorphism gives protection against regain of weight lost. Moreover, the presence of the Ala allele of the PPARgamma-2 together with the C allele strengthens this protection. These findings support a role for these polymorphisms on weight regulation and suggest a synergetic effect of both variants on weight maintenance after following a diet to lose weight.     

Gastric carcinoid: case report and review of the literature

Carcinoids are rare tumour of neuroendocrin origin, characterized by argyrophylic silver stain reaction, positive immunohistochemical reaction with neuron-specific markers, a typical growth pattern; they can express different peptides and biogenic amines. Gastric carcinoid tumours have been classified on the basis of susceptibility to gastric trophic stimulus and characteristics mucosal surrounding into 3 different types. This classification is important with respect to therapeutic strategy (type adapted treatment), but the option of endoscopic or surgical treatment is influenced by the impossibility to distinguish clearly the benignity or malignity of these lesions. A review of international literature and a rare case of gastric carcinoid tumour associated with chronic athrophic gastritis, developed in a female 65-years old, with anaemia and treated by subtotal gastrectomy, are presented.     

Initial experience with bosentan therapy in patients considered ineligible for heart transplantation because of severe pulmonary hypertension

BACKGROUND: Pre-operative elevated pulmonary vascular resistance (PVR) has been associated with increased right ventricular failure and mortality after heart transplantation. The aim of this study was to assess the efficacy of bosentan, an oral endothelin-receptor antagonist, to reduce PVR in patients considered ineligible for heart transplantation because of severe pulmonary hypertension. METHODS: Seven patients with end-stage congestive heart failure and considered ineligible for heart transplantation because of severe pulmonary hypertension (PVR>2.5 Wood units after nitroprusside infusion) were included in the study. They received bosentan 62.5 mg b.i.d. for four wk and 125 mg b.i.d. thereafter. Right heart catheterization was repeated after six wk of therapy. RESULTS: After six wk of bosentan therapy, there was a significant decrease in PVR (6.0 +/- 2 vs. 3.8 +/- 2 Wood units, before vs. after bosentan; p = 0.02), in PVR during nitroprusside infusion (3.3 +/- 1 vs. 2.1 +/- 1 Wood units, before vs. after bosentan; p = 0.02) and in diastolic pulmonary artery pressure (33 +/- 7 vs. 23 +/- 7 mmHg, before vs. after bosentan; p = 0.04). No significant adverse events were observed. After bosentan therapy, five patients had PVR相似文献   

Obturator hernia as a cause of chronic pain after inguinal hernioplasty: elective management using tomography and ambulatory total extraperitoneal laparoscopy

Obturator hernia is a rare variety of pelvic hernia. Preoperative diagnosis is still uncommon and influences treatment and prognosis. Clinical suspicion and tomography are fundamental for establishing a preoperative diagnosis. Subsequently, elective treatment via the total extraperitoneal laparoscopic approach seems to offer the best results for both the patient and the hospital. This management might reduce the high rates of associated morbidity and mortality. We present the case of a patient with chronic pelvic pain after hernia surgery in whom tomography confirmed the existence of a bilateral obturator hernia. Details are given of diagnostic and therapeutic management using ambulatory total extraperitoneal laparoscopy. We recommend ruling out obturator hernia as a possible cause of chronic pain after hernia repair.     

Continuous EMG recordings and intraoperative electrical stimulation for identification and protection of cervical nerve roots during foraminal tumor surgery

OBJECTIVE: Spinal cord function is now routinely monitored with somatosensory evoked potentials (SEPs) and motor evoked potentials (MEPs) during surgery for intraspinal cervical dumbbell and foraminal tumors. However, upper extremity nerve roots are also at risk during these procedures. Anatomic relations are frequently difficult to interpret because the nerve roots may be displaced by the tumor. We used electrical stimulation with compound muscle action potential (CMAP) recordings at multiple sites to identify the location and course of the involved nerve root and to provide real-time information regarding the functional status of the roots to predict postoperative outcome. METHODS: Ten patients were monitored during surgery for cervical dumbbell or foraminal tumors. SEPs and MEPs were monitored as a routine procedure. CMAPs were recorded from needle electrodes placed in the deltoid, biceps, triceps, and flexor carpi ulnaris muscles. Spontaneous electromyography (EMG) muscle activity was also continuously monitored. A handheld monopolar stimulation electrode was used to elicit evoked EMG responses to identify and trace the course of nerves in relation to the tumor. In four patients, the stimulation threshold was tested before and after tumor resection to predict postoperative nerve root function. RESULTS: Electrical stimulation with CMAP recording was successful in localizing nerve roots during tumor resection in all 10 patients. Monitoring predicted postoperative nerve root preservation after tumor removal in each case. It was possible to identify either by using low-level stimulation (<2.0 V) or by observing changes in spontaneous EMG amplitude if activation was present during surgical dissection. The monitoring of spontaneous muscle activity in response to direct or indirect surgical manipulation during tumor resection also provided continuous assessment of nerve root function and identified any physiologic disturbance induced by surgical manipulation. CONCLUSIONS: Electrical stimulation in the operating field and recording of CMAPs facilitated nerve root identification and predicted postoperative function during dissection and separation from ligamentous or neoplastic tissue in 10 patients. Electrical stimulation might also be useful to predict postoperative preservation of function when nerve root sacrifice is necessary and no motor response is detected intraoperatively.     

Is methylene blue of benefit in treating adult patients who develop catecholamine-resistant vasoplegic syndrome during cardiac surgery?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether methylene blue (MB) is of benefit in treating adult patients who develop catecholamine-resistant vasoplegic syndrome (VPS) during cardiac surgery. Altogether 47 papers were found in Medline and 107 in Embase using the reported search. A further five papers were found by hand-searching reference lists. Four papers represented the best evidence on the subject and details of authors, journal, date and country of publication, patient group, relevant outcomes and weaknesses were tabulated. In addition, a further 14 papers are referenced to aid the discussion. We conclude that MB may provide an interesting and novel therapeutic option for adult patients who develop catecholamine-resistant VPS during cardiac surgery. Whilst there is currently insufficient evidence to advocate its use as first-line therapy it should be considered as a possible 'rescue therapy' in catecholamine-resistant VPS and some work has suggested that it may have a prophylactic role in preventing VPS. However, further large well-controlled studies are required before its routine use can be recommended.     

Risk factors and incidence of posttransplant diabetes mellitus in Mexican kidney recipients

BACKGROUND: Many risk factors are associated with the development of posttransplant diabetes mellitus (PTDM), which has adverse effects on graft and patient survival. We report the incidence and risk factors associated with the development of PTDM in Mexican kidney recipients. METHODS: In a retrospective cohort study, we included kidney transplants performed between January 1, 1994 and December 31, 2000; all patients were followed up for at least 1 year posttransplantation. PTDM was defined as fasting blood glucose >126 mg/dL on at least two occasions. Statistical analysis included estimation of crude relative risk (RR) with 95% confidence intervals (CI). Adjusted RR and 95% CI by logistic regression were used. RESULTS: We studied 522 kidney recipients. Fifty three (10.1%) cases of PTDM were identified in this cohort. Cumulative dosage of prednisone (PDN) >13 g (RR 7.6, 95% CI 1.5-16.3 p <0.0001) and the presence of >or=1 acute rejection episodes (RR 3.7, 95% CI 1.2-11.6 p <0.001 were independent risk factors associated with the development of PTDM. Obesity (RR 2.6, 95% CI 0.8-8.7, p = 0.083) and age range of 40-49 years (RR 2.0; 95% CI 0.6-7.2, p = 0.093) were identified as marginal risk factors. CONCLUSIONS: The incidence of PTDM in kidney recipients was 10.1% in our population. Cumulative PDN dosage and presence of >or=1 acute rejection episodes were independent risk factors for the development of PTDM. These results are consistent with prior studies of the diabetogenic effect of the PDN. The relationship between acute rejection and PTDM deserves further investigation in order to learn more about the role that inflammatory mechanisms may play in this association.     

Management of patients with non-functioning gastroentero-pancreatic neuroendocrine tumours

The Authors examine the feasibility of diagnosing non-functioning gastroentero-pancreatic neuroendocrine tumours preoperatively or intraoperatively, with particular reference to laboratory examinations and octreoscan scintigraphy, which are capable of conditioning the surgical treatment and subsequent follow-up. Of the 4 cases reported here: three presented multiple intestinal localizations, and in only one case the origin of the primitive carcinoma was undefined. The suspicion of a non-functioning neuroendocrine tumour must be considered when yellowish or ochre-coloured intestinal lesions are found intraoperatively. Determination of specific markers and octreoscan scintigraphy must be performed without awaiting histological confirmation. Surgery plays a fundamental role in the debulking of these carcinomas. However, medical therapy with the aid of specific laboratory examinations and octreoscan scintigraphy may improve the long-term survival.