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Introduction: Despite recent attempts to reach a consensus on the diagnostic criteria and treatment of dumping syndrome (DS) after bariatric surgery, many questions about the clinical applicability and significance of standardized provocation tests remain unanswered. The objective of this study was to retrospectively evaluate a mixed-meal-test (MMT) based on general nutritional recommendations after bariatric surgery and its clinical value in diagnosing DS., Methods: The MMT contained 15.5 g of protein, 10 g of fat, 20.7 g of carbohydrates, and 3.1 g of dietary fiber, totaling 241 kcal. Symptoms based on the Sigstad Score, along with blood sugar, hematocrit, pulse rate, and blood pressure, were collected as primary readouts. The analysis included 58 MMTs from 56 patients who reported postprandial symptoms indicative of DS and were referred to the clinic by surgeons or general practitioners., Results: Although all individuals reported significant symptoms at home, the MMT showed a positive symptom score (Sigstad Score ≥7) in only 16 cases (28%). Neither a heart rate increase >10 BPM nor the 3% hematocrit increase suggested as cut-offs for early DS by the consensus paper were associated with the Sigstad Score or individually reported symptoms. None of the participants had a postprandial glucose decrease below 50 mg/dL; one fell below 60 mg/dL and 14 fell below 70 mg/dL. A blood glucose decrease below 70 mg/dL was not associated with symptoms., Conclusion: The MMT showed that only a minority of patients reported classical DS symptoms under controlled conditions. Changes in hematocrit, heart rate, and blood sugar decrease below 70 mg/dL did not help to predict symptoms in the individuals studied. The data, in the context of existing evidence, suggest that provocation tests have little value in clinical practice and that DS as a clinical entity after bariatric surgery should be reevaluated., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Background: Raynaud disease (RD) is a common disorder affecting 3% to 5% of the healthy population, and occurs in more than 90% of patients with connective tissue diseases. The therapeutic options remain limited, particularly in patients with secondary RD due to connective tissue disease. Theoretical considerations lead to the expectation that phosphodiesterase type 5 inhibitors may improve clinical symptoms and digital blood flow in patients with RD., Methods: We conducted an open-label pilot study in 40 patients with RD, 33 (82%) of whom had secondary and 7 (18%) of whom had primary RD. Digital blood flow was measured by laser-Doppler flowmetry at room temperature and during the cold-exposure test before medical treatment, 1 hour after the initial intake, and after 2 weeks of continuous treatment (10 mg twice a day) with the novel phosphodiesterase type 5 inhibitor vardenafil. Clinical symptoms were recorded by a patient questionnaire and summarized as the Raynaud condition score., Results: Laser-Doppler flowmetry revealed that vardenafil improved digital blood flow in 28 (70%) patients, whereas 12 (30%) did not respond. In individuals responding, digital blood flow significantly increased by a mean +/- SEM of 21.0% +/- 4.9% and 30.0% +/- 5.7% at 1 hour and 2 weeks of treatment at room temperature, respectively, and by 18.8% +/- 4.4% and 35.1% +/- 7.5% at 1 hour and 2 weeks during the cold-exposure test, respectively (P < .01 for all). Consistently, clinical symptoms improved in 27 (68%) of the 40 patients, and the Raynaud condition score declined from a mean +/- SEM of 5.05 +/- 0.38 to 3.54 +/- 0.31 (P < .001)., Conclusion: Our data indicate that phosphodiesterase type 5 inhibition significantly improves peripheral blood flow and clinical symptoms in a large subset of patients with RD and, thus, may provide a novel therapeutic approach in such individuals.

Objective: We compared peripheral nerve blocks (PNB, femoral nerve block together with anterior sciatic nerve block) as sole anaesthetic with epidural anaesthesia (EA) in a randomised study in patients undergoing elective arthroscopic knee surgery with respect to patient satisfaction and time required to perform each procedure., Methods: 99 ASA class I-III patients were randomised to either PNB (20 ml bupivacaine 0.5 % + 60 ml prilocaine 1 %) or EA (12 - 20 ml bupivacaine 0.5 %)., Endpoints: patient satisfaction with the anaesthetic evaluated by a questionnaire 3 months after the operation, anaesthesia and surgical times, need for additional analgesics and the modified Aldrete-score (global assessment of postanaesthetic condition) at admission in the postanaesthesia care unit., Results: Significantly more patients in the PNB compared to the EA group needed intravenous opioid supplementation (10 vs. 3, p = 0.040). While the patients in the PNB group had a significantly higher modified Aldrete score (9.3 +/- 0.7 vs. 8.8 +/- 0.9, p = 0.0009), assessment (0 = worst, 10 = best) of the induction of PNB or EA respectively, was significantly better rated in the EA compared to PNB group (8.7 +/- 2.1 vs. 6.7 +/- 2.6, p = 0.0024). Assuming that the willingness to undergo the same anaesthetic again reflect overall satisfaction with the procedure satisfaction in both groups was high: 25/26 (PNB) and 27/28 (EA) would have preferred their regional blockade (p = 0.95)., Conclusion: Patients in the PNB and EA group both were satisfied with their anaesthetic procedure. While there are obviously differences in favour of the EA, PNB is an alternative in the case of contraindication or patient rejection to EA.

History: A 65-year-old woman was admitted because of dyspnea at rest and peripheral edema due to scleroderma-associated pulmonary fibrosis and hypertension, as well as Raynaud's phenomenon., Diagnostic Features, Treatment and Course: She had a marked restrictive ventilatory disorder with severe impairment of diffusion capacity. Right heart catheterization demonstrated a mean pulmonary artery pressure of 50 mmHg. She was able to walk only 220 m. All usual methods of treatment failed to give satisfactory results so that sildenafil (phospherodiesterase type-5 |PDE-5| inhibitor; Viagra ((R)) was given, even though it is not licensed for this indications ("off-label", as a therapeutic attempt. This achieved definite reduction in pulmonary arterial pressure and significantly improved the clinical symptoms. In particular, it drastically reduced the level of atrial natriuretic peptide, an important prognostic marker in right heart failure. Sildenafil also significantly raised peripheral perfusion and the signs of Raynaud's syndrome., Conclusion: PDE-5 inhibitors are efficacious in scleroderma-associated pulmonary hypertension and may also provide a new option in the treatment of Raynaud's disease.

Background: Local side effects at the injection sites of low-molecular-weight heparins are rare and can be of immunologic or nonimmunologic origin. Calcinosis cutis is a rare disorder and occurs in various circumstances. In patients with chronic renal failure the risk of pathologic calcifications is raised due to elevated calcium-phosphorus products., Objective: Five patients suffering from renal failure developed remarkable cutaneous and subcutaneous nodules or plaques following subcutaneous nadroparin-calcium injections. Our aim was to evaluate the morphology and precipitation factors of these calcifications and to discuss immunological and nonimmunological differential diagnoses., Methods: Histological examination, spectroscopic analysis, ultrasonography, allergy testing and reexposition testing including non-calcium heparins were performed., Results: Histology using the van Kossa staining technique revealed calcinosis of the dermis and subcutis. Ultrasonography showed focal subcutaneous calcifications. In all patients the calcium-phosphorus products were elevated., Conclusion: Clinicians should be aware that patients with renal failure and elevated calcium-phosphorus products may be at risk of developing calcinosis cutis at calcium-containing heparin injection sites. As a consequence, we propose the use of non-calcium heparins in these patients.

Recent (since 1960) data on the lipid content and fatty acid composition of fish were surveyed as part of the continuing USDA program to provide information on the nutrient composition of foods. Tabulated values of total lipid and fatty acids in finfish are presented. The most prominent fatty acids occurring in finfish are palmitic (C16:0), C18:1 (in some species C20:1 and C22:1), and the highly polyunsaturated C20:5 and C22:6. The general nutritional value of finfish is discussed. Two measures of polyunsaturation are presented for some commercially important domestic finfish: the total amount of polyunsaturated fatty acids (PFA) and the relative degree of polyunsaturation (PI).

An extensive survey of the post-1960 literature on the lipids of fowl has been completed. This review shows that the total lipid content of chicken tissues increases with age. The fatty acid composition of both chicken and turkey tissues reflects the fatty acid composition of the dietary fat. The fatty acid composition data for dark meat, light meat, or skin of all classes of chicken --broiler-fryer, roaster, and stewing hen--raised on diets equivalent to commercial feed were combined into single tissue-type fatty acid profiles. Similar profiles were also established for roaster-fryer turkey, young tom turkey, and young hen turkey. Breed, sex, and environmental temperature showed only minor effects on the tissue fatty acid compositions. Young chicken flesh contains less fat than that of stewing hens, turkeys, and other fowl, which all have approximately equal total fat content. White meat of chicken and turkey contains the least amount of fat, and the skin of all birds contained the largest amount, duck and goose skin containing the greatest of all. Tables of the total fat and fatty acid composition of tissue and tissue composites of fowl are given. Studies on chicken and turkey tissues were sufficiently numerous that the computed fatty acid compositions in the tables are considered reliable representation of market birds. Data for goose, duck, partridge, pheasant, pigeon, and quail were computed from sparse information and should be viewedas provisional guides.

The caloric content of foods listed in food composition tables, such as the USDA Agriculture Handbook No. 8, is calculated by multiplying the gram amount of the protein, fat, and carbohydrate in the food by specific caloric factors derived around the turn of the century by Atwater and co-workers. To evaluate the accuracy of these specific caloric factors, we determined the heats of combustion of vegetable oils as purchased; of lipids extracted from red meats, chicken, fish, egg yolk, and cereal grains; and of the residue (protein) left after lipid extraction of the meats. These heats of combustion were converted to available energy values by the method of Atwater . The specific caloric factors used to calculate the caloric content of foods in Agriculture Handbook No. 8 and other tables of food composition may exaggerate the calories contributed by the lipids in some foods. When the food lipid was mainly triglyceride, the available energy values calculated in this study were within 2% of the specific factors used in Agriculture Handbook No. 8. However, when the food lipid had a high content of phospholipid, our calculated available energy values were lower than the specific factors used currently. The energy content of the fat-free residue (protein) of meat, poultry, and fish was also less than that currently used for those foods in food composition tables.

Based on production volume and value and on per capita consumption, shellfish are an important food group in the United States. The nutrient composition of shellfish indicates that this food group is low in fat and relatively high in protein. Tabulated data on fatty acids in the different edible portions of seven species of crustaceans and over twenty species of mollusks are presented. The proportionately high level of polyunsaturated fatty acids is shown by the polyunsaturation index calculated for some important species of shellfish.

Information on total lipid and fatty acid composition or cereal grains and their products used for food has been collated in a comprehensive search of world literature published since 1960. Data considered most suitable for use for representing contents of total lipids and fatty acids have been tabulated and are presented. In developing these data, attention was given to stability and other chemical properties of the lipids, lipid composition of the different parts of the grain, and to such factors as genetics, production, processing, and analytical methods used in extracting and determining the fat and fatty acids in cereal products.

This paper summarizes representative values for the fatty acid composition of unprocessed vegetable fats, vegetable oils, and animal fats. The data for these unprocessed fats and oils are identical with those of the processed, but unhydrogenated fats and oils. Calculations to convert the fatty acid methyl ester data to grams fatty acid per 100 gm. food are discussed, and the converted data are presented in tabular form. Climatic and cultivar effects on the fatty acid composition of some of these oils are reviewed.

A search of the literature has been conducted on the cholesterol content of foods and on the methods for its determination. The amount of cholesterol in food is important because of its possible relationship to the onset of atherosclerosis in humans. Cholesterol is present primarily in foods of animal origin. The main sources in the American diet are eggs, poultry, dairy products, fish and seafood, and meat products. Only a few samples of these products have been analyzed. In many cases there is a wide range in cholesterol values for samples analyzed. Much of the research was conducted many years ago. The most commonly used methods were gravimetric or colorimetric. In many cases the samples investigated were not adequately described. Cholesterol was often determined without isolating it from interfering materials. Although some of the cholesterol values reported in the literature appear to be reasonably accurate, there is an urgent need for reinvestigation of the cholesterol content of foods using more recently developed methods of analysis.

Tables showing representative values for the vitamin E content of human foods have been developed from all the available reliable information. These tables cover animal products, plant products, fats and oils, baked products, infant foods, and mixed dishes. The effects on vitamin E content are discussed for heating and storage of dairy products, grains, vegetables, and plant oils; for the refining of plant oils; and for the processing and baking of grain products. Causes of variation in vitamin E levels are presented and the distribution of the different forms of vitamin E in foods is shown. The biologic activities of these forms are used to calculate approximate vitamin activity values of representative foods.

As part of USDA research to provide reliable and up-to-date tabulations of lipids and fatty acids in foods, representative values have been derived and tabulated for nuts and commercially canned condensed soups. Except for palm-type nuts, unsaturated fatty acids are the major acids in nuts; oleic acid is generally the predominant unsaturated fatty acid. The new fatty acid values indicate greater concentrations of saturated fatty acids than previously reported. The P:S ratios for nuts and peanuts are presented. The fatty acid contents of soups are varied and reflect the lipid composition of the source(s) of fat of the particular ingredients used in the manufacture of these products. These new values for fatty acids in nuts and soups should greatly help nutritionists and dietitians to better assess the total contribution of each particular fatty acid to the diet.

Available data on phytosterols from the world's literature have been compiled and summarized. There still exists a paucity of data on the quantities of plant sterols in many foods. More extensive data are available on the relative sterol composition. Our compilation shows that plant oils are excellent sources of phytosterols. Nuts and seeds contain moderate levels, and fruits and vegetables generally contain the lowest concentrations of plant sterols. Analyses of the minor sterols, namely, the delta5- and delta7-phytosterols, have become available only recently.

As a result of critical review of information on lipid composition of foods, representative values have been derived for the lipid and fatty acid contents of lamb and veal. Comprehensive tabulations of fatty acids in 100-gm. portions of raw and cooked retail cuts are given. The mean fatty acid profiles of the lean and adipose tissues which were used for computing the fatty acid values in the food tables are presented. The lean tissue lipid of lamb contains a significant amount of caprylic, arachidic, and arachidonic acids which are not present in the adipose tissue. A comparison of beef and veal shows that veal lipid is a richer source of polyunsaturated fatty acids. The new values presented here for fatty acids in lamb and veal should provide nutritionists and dietitians better means for evaluating diets.