Danilo Castellani

Novel Soy Germ Pasta Improves Endothelial Function, Blood Pressure, and Oxidative Stress in Patients With Type 2 Diabetes

OBJECTIVE To compare the effects of a novel soy germ–enriched pasta, containing isoflavone aglycons, with conventional pasta on endothelial function and cardiovascular risk markers in patients with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS This randomized controlled double-blind crossover study compared one serving/day of soy germ pasta and conventional pasta for 8 weeks for effects on brachial artery flow-mediated vasodilation, blood pressure, plasma lipids, oxidized LDL cholesterol, 8-iso-PGF2α, total antioxidant capacity (TAC), glutathione (GSH), and homocysteine. RESULTS Isoflavone-enriched pasta significantly improved arterial stiffness (P = 0.005) and reduced systolic (P = 0.026) and diastolic (P = 0.017) blood pressures. Plasma TAC increased (P = 0.0002), oxidized LDL cholesterol decreased (P = 0.009), 8-iso-PGF2α decreased (P = 0.001), GSH levels increased (P = 0.0003), and homocysteine decreased (P = 0.009) consistent with a reduction in oxidative stress. No significant changes were observed with conventional pasta. CONCLUSIONS Pasta enriched with biologically active isoflavone aglycons improved endothelial function and had beneficial effects on cardiovascular risk markers in patients with T2D.

Colonic propulsive and postprandial motor activity in patients with ulcerative colitis in remission

Background Although it is known that colon motility is abnormal in ulcerative colitis, data are still scarce with regard to the underlying mechanisms. Recent evidence suggests that the propulsive activity is highly increased during the active phase of the disease, probably contributing to the diarrhoea. However, data are even scarcer in the quiescent phase of the disease. Aims To assess the colonic high-amplitude and low-amplitude propulsive activity and the colonic motor response to eating in patients with ulcerative colitis in remission. Patients and methods Fourteen patients were recruited, all with the disease in remission as documented by clinical and endoscopic criteria. Twenty-four hour manometric recordings were obtained in these patients, and compared to those of 16 healthy controls. Results The high-amplitude propagated contractions were similar in both groups (5.8±2.6 events in ulcerative colitis patients and 5.5±0.8 in controls (P=0.13)), whereas patients tended to display a higher number of low-amplitude propagated events (134.4±34 vs. 60.9±16 in controls (P=0.058)). No differences were found in the colonic motor response to eating between patients and controls. Conclusions Colonic propulsive activity in ulcerative colitis in remission is almost normal, even though the low-amplitude propagated activity tends to be similar to that observed in patients with the irritable bowel syndrome, thus possibly contributing to the persistence of abdominal symptoms in a subgroup of patients.

Small intestinal bacterial overgrowth and warfarin dose requirement variability

The dose of warfarin needed to obtain a therapeutic anticoagulation level varies widely among patients and can undergo abrupt changes for unknown reasons. Drug interactions and genetic factors may partially explain these differences. Intestinal flora produces vitamin K2 (VK2) and patients with small intestinal bacterial overgrowth (SIBO) rarely present reduced INR values due to insufficient dietary vitamin K. The present study was undertaken to investigate whether SIBO occurrence may affect warfarin dose requirements in anticoagulated patients. Based on their mean weekly dose of warfarin while on stable anticoagulation, 3 groups of 10 patients each were defined: low dose (LD, <or=17.5 mg/wk of warfarin); high dose (HD, from 35-70 mg/wk); and very high dose (VHD>or=70 mg/wk). Each patient underwent a lactulose breath test to diagnose SIBO. Plasma levels of warfarin and vitamin K-analogues were also assessed. Patients with an altered breath test were 50% in the VHD group, 10% in the HD group, and none in the LD group (P=0.01). Predisposing factors to SIBO were more frequent in the VHD group, while warfarin interfering variables were not. VHD patients were younger and had a higher plasma vitamin K1 (VK1) concentration (P>0.05). On the contrary, the plasma VK2 levels tended to be lower. This pilot study suggests that SIBO may increase a patients warfarin dose requirement by increasing dietary VK1 absorption through the potentially damaged intestinal mucosa rather than increasing intestinal VK2 biosynthesis. Larger studies are needed to confirm these preliminary data and to evaluate the effects of SIBO decontamination on warfarin dosage.

Novel Soy Germ Pasta Enriched in Isoflavones Ameliorates Gastroparesis in Type 2 Diabetes: A pilot study

OBJECTIVE To determine the effect of soy germ pasta enriched in biologically active isoflavone aglycons on gastric emptying in type 2 diabetic patients with gastroparesis. RESEARCH DESIGN AND METHODS This randomized double-blind, placebo-controlled study compared soy germ pasta with conventional pasta for effects on gastric emptying. Patients (n = 10) with delayed gastric emptying consumed one serving per day of each pasta for 8 weeks, with a 4-week washout. Gastric emptying time (t1/2) was measured using the [13C]octanoic acid breath test at baseline and after each period, and blood glucose and insulin concentrations were determined after oral glucose load. RESULTS Soy germ pasta significantly accelerated the t1/2 in these patients (161.2 ± 17.5 min at baseline vs. 112.6 ± 11.2 min after treatment, P = 0.009). Such change differed significantly (P = 0.009) from that for conventional pasta (153.6 ± 24.2 vs. 156.2 ± 27.4 min), without affecting glucose or insulin concentrations. CONCLUSIONS These findings suggest that soy germ pasta may offer a simple dietary approach to managing diabetic gastropathy.

Pseudo-pseudo-obstruction.

Chronic intestinal pseudo-obstruction is a clinical syndrome characterised by symptoms and signs of intestinal obstruction in the absence of a mechanical lesion of the intestinal lumen. The diagnosis is often difficult and relies on clinical, radiological and manometric grounds. We present here a case in which such a diagnosis was suspected, but a thorough in-depth evaluation revealed that the symptoms were due to a treatable cause--abdominopelvic adhesions.

Pancreatic adenocarcinoma in paraduodenal pancreatitis: a note of caution for conservative treatments.

Paraduodenal pancreatitis in heterotopic pancreas is a rare condition and few cases of malignant transformation are described. A case of cystic dystrophy of the duodenal wall in heterotopic pancreas complicated with pancreatic adenocarcinoma is described. Computed tomography, magnetic resonance and endoscopic ultrasonography failed to show preoperatively, the locally advanced adenocarcinoma raising reasonable doubts on the effectiveness and safety of conservative treatments for paraduodenal pancreatitis.

Duodenal submucosal tunnelization by fishbone.

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A simplified method for anal ultrasonography: preliminary report.

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A simplified method for anal ultrasonography: assessment of patient satisfaction and the simplicity of the procedure

Background Anal endosonography (AES) is able to reliably visualize and identify anal sphincter abnormalities. However, dedicated probes are quite expensive. Aim We describe a simple and less costly method to perform AES in a unit that already has echoendoscopes available by inserting the endoscope through a disposable anoscope filled with standard ultrasound gel. Patients Subjects without anal abnormalities and patients with anal disease (abscesses, fistulas) were evaluated. Results Good-quality images were obtained in both controls and patients, with optimal visualization of the anatomic structures and pathologic features. The latter (abscesses, fistulas) were always confirmed by magnetic resonance imaging. Conclusions This simple and less costly method allows to perform good-quality AES in units having echoendoscopes availability, without the need of a more expensive dedicated probe.

S-Equol, a potent ligand for estrogen receptor β, is the exclusive enantiomeric form of the soy isoflavone metabolite produced by human intestinal bacterial flora

BackgroundAnal endosonography reliably visualizes and identifies anal sphincter abnormalities. However, dedicated probes are quite expensive. We evaluated a simple and less-costly procedure for anal endosonography involving the insertion of the endoscope through a disposable anoscope filled with standard ultrasound gel in terms of patient satisfaction and the simplicity of the procedure in comparison with the standard technique in a unit that already had echoendoscopes available.MethodsThe two techniques were used in 35 subjects without anal abnormalities and data on the simplicity of the procedures, patient discomfort, the quality of images, and the time needed to perform the procedures were compared.ResultsAll the variables under investigation scored significantly better with the modified technique compared to the standard one. No differences in thickness of either the internal or the external anal sphincter were found between the two methods.ConclusionsThis simple and less-costly adaptation of anal ultrasonography allows good quality examinations to be performed with better patient comfort in units with echoendoscopes already available, avoiding the need for a more expensive dedicated probe.