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Background: Amyloidosis is a large family of diseases defined by the presence of extra cellular protein deposits which can remain localised but are generally diffuse. Pleural involvement with effusion is rare (6% only), and difficult to diagnose because the clinical signs are non-specific., Observation: We report the case of a 77 year old man, hospitalized for anasarca, with recurring pleural effusions despite two drainages and talcage. Pleural aspiration revealed a chylothorax. ProBNP was high: 24000 ng/l. Echocardiography revealed a restrictive cardiomyopathy and suggested the diagnosis of a systemic disease. Negative peripheral biopsies led us to perform an endomyocardial biopsy, which confirmed the diagnosis of amyloidosis AL., Conclusion: We report an original case of primary amyloidosis presenting as a chylothorax and confirmed by an endomyocardial biopsy. We highlight the multi factorial character of pleural effusions associated with amyloidosis. This explains the delay in treatment and the disease's critical nature (median survival 2 months). The prognostic value of proBNP is also emphasised.

This research evaluates the ascorbic acid loss of vegetables prepared in a hospital cook-chill plated system. The ascorbic acid loss of three vegetable samples (carrots, peas and potatoes) were measured at various points in the cook-chill system and analysed using the DCPIP method. Substantial losses for all vegetables were identified at the cooking and regeneration stages. The ascorbic acid levels of the selected vegetables when raw ranged from 6 to 10 mg/100 g sample. At the end of the food service cycle the ascorbic acid content of the vegetables was reduced to 1.7-5.8 mg/100 g sample. The largest percentage loss of ascorbic acid, i.e. 76%, was found in mashed potatoes. Peas incurred the least percentage loss, i.e. 42%. This progressive deterioration during the cook-chill plated catering system causes an insubstantial presence of ascorbic acid in the food served to hospitalised patients.

Malnutrition among renal patients has been widely documented and is associated with increased morbidity and mortality. Advances in dialysis technology and transplantation have helped to increase patient long-term survival, and as more elderly patients commence dialysis programs, the problem of malnutrition is escalating. Hospitalized renal patients are at a greater risk, as dietary intakes may be reduced for a number of reasons. A multidisciplinary team decided to review the existing cook-chill plated meal system and all food provision to the renal ward. The aim of this review was to assess the nutritional intake of renal inpatients and to gauge patients' and relatives' attitudes towards hospital food provision. From these results, we hoped to go on and implement some changes to help improve the situation. Results showed that 34% of the patients ate half or less of the hospital food provided, and 80% of patients surveyed relied on food brought in by relatives and friends. Actual dietary intakes were compared to Dietary Reference Values (DRVs; Department of Health [DoH], UK, 1995). One hundred percent of the patients did not achieve the DRVs for energy, iron, potassium, zinc, folate, B6, and riboflavin. Sixty-six percent of the patients did not achieve the DRV for protein. These results were discussed by the multidisciplinary group, and it was decided to trial a cook-chill bulk trolley to replace the existing plated meal system. Unfortunately, to implement a bulk trolley system, the ward needs someone to serve the food. This could be the job of a "feeding assistant" or "ward hostess." A bid has been put forward to the hospital Trust Board to obtain funding for these "feeding assistants, " and the bulk trolley can be acquired from existing funds. It is hoped that the creation of these new posts will go some of the way towards improving the patients' dietary intake while in the hospital.