Hannaford is your source for delicious ideas, including exclusive recipes from Hannaford Fresh Magazine and recipes rated by Guiding Stars for better nutrition. LOW OXALATE DIET Why to control oxalates in food? People suffering from a tendency to develop calcium-oxalate kidney stones should avoid eating high oxalate.
Resveratrol . Two randomized, placebo- controlled trials reported that one- year consumption of a grape supplement containing 8 mg/day of resveratrol improved inflammatory and atherogenic status in subjects at risk for cardiovascular disease, as well as in patients with established coronary heart disease. Yet, there is currently no evidence that the content of resveratrol in red wine confers any additional risk reduction beyond that attributed to the alcohol content and to other wine polyphenols. Certain plants produce resveratrol and other stilbenoids in response to stress, injury, fungal infection, or ultraviolet (UV) radiation (2). Resveratrol is a fat- soluble compound that occurs in both trans and cis molecular configurations (Figure 1). Both cis- and trans- resveratrol also occur as glucosides, i. One major resveratrol derivative is resveratrol- 3- O- . Specifically, it was postulated that resveratrol intake via moderate red wine consumption might help explain the fact that French people have a relatively low incidence of coronary heart disease (CHD) in spite of consuming foods high in saturated fat, a phenomenon dubbed the “French Paradox” (see Cardiovascular disease) (5). Since then, reports on the potential for resveratrol to prevent cancer, delay the development of cardiovascular and neurodegenerative diseases, improve glycemic control in type 2 diabetes, and extend lifespan in experimental models have continued to generate scientific interest (see Disease Prevention). Metabolism and Bioavailability. Initial studies of the pharmacokinetics of trans- resveratrol in humans found only traces of the unmetabolized resveratrol in the plasma upon oral exposure of single trans- resveratrol doses of 5 to 2. Indeed, trans- resveratrol appears to be well absorbed by humans when taken orally, but its bioavailability is relatively low due to its rapid metabolism and elimination (6). Once absorbed, resveratrol is rapidly metabolized by conjugation to glucuronic acid and/or sulfate, forming resveratrol glucuronides, sulfates, and/or sulfoglucuronides. Sulfate conjugates are the major forms of resveratrol metabolites found in plasma and urine in humans (7). Preliminary studies found that the administration of single oral doses of 2. A study in 4. 0 healthy subjects who received single ascending doses of oral trans- resveratrol (i. Of note, these values were markedly below those used to elicit chemopreventive effects of resveratrol in in vitro experiments (> 5 . In contrast, following a single oral dose of 5 g of trans- resveratrol, the peak plasma concentrations of certain resveratrol conjugates were found to be about two to eight times higher than those of unmetabolized resveratrol (1. Also, compared to a single dose administration, the repeated intake of 5 g/day of trans- resveratrol for 2. Repeated doses of 1 g/day of trans- resveratrol (a dose less likely to cause side effects; see Safety) could yield maximum plasma concentrations of about 2. One study has reported that bioavailability of trans- resveratrol from red wine did not differ when the wine was consumed with a meal (low- or high- fat) versus on an empty stomach (1. You get vitamin K from green, leafy vegetables such as spinach and kale. But bacteria in your small intestines. Yet, in another study, the absorption of supplemental resveratrol was found to be delayed, but not reduced, by the presence of food in the stomach (1. A third study found that the bioavailability of supplemental resveratrol was reduced by the amount of fat in the diet, but not by the co- administration of quercetin (another polyphenol) or alcohol (1. Information about the bioavailability of resveratrol in humans is important because most of the experimental research conducted to date has been . While cells that line the digestive tract are exposed to unmetabolized resveratrol, other tissues are likely exposed to resveratrol metabolites. At present, little is known about the biological activity of resveratrol metabolites. Yet, if some tissues are capable of converting resveratrol metabolites back to resveratrol, stable resveratrol conjugates in tissues could serve as a pool in the body from which resveratrol might be regenerated (6, 1. Biological Activities. The biological significance of resveratrol has been primarily investigated in test tubes and cultured cells, and to a lesser extent, in animal models. Of note, a recent publication by Tom. It is important to keep in mind that many of the biological activities discussed below were observed in cells cultured in the presence of resveratrol at higher concentrations than those likely to be achieved in humans consuming resveratrol orally (see Metabolism and Bioavailability). Direct antioxidant activity. In the test tube, resveratrol effectively scavenges (neutralizes) free radicals and other oxidants(1. LDL) oxidation(1. Resveratrol was found to induce antioxidantenzymes, including superoxide dismutase (SOD), thioredoxin, glutathione peroxidase- 1, heme oxygenase- 1, and catalase, and/or inhibit reactive oxygen species (ROS) production by nicotinamide adenine dinucleotide phosphate (NADPH) oxidases (NOX) (2. However, there is little evidence that resveratrol is an important antioxidant in vivo. Upon oral consumption of resveratrol, circulating and intracellular levels of resveratrol in humans are likely to be much lower than that of other important antioxidants, such as vitamin C, uric acid, vitamin E, and glutathione. Moreover, the antioxidant activity of resveratrol metabolites, which comprise most of the circulating resveratrol, may be lower than that of resveratrol (2. Estrogenic and anti- estrogenic activities. Endogenousestrogens are steroidhormonessynthesized by humans and other mammals; these hormones bind to estrogen receptors within cells. The estrogen- receptor complex interacts with unique sequences in DNA (estrogen response elements; EREs) to modulate the expression of estrogen- responsive genes(2. The chemical structure of resveratrol is very similar to that of the synthetic estrogen agonist, diethylstilbestrol (Figure 2), suggesting that resveratrol might also function as an estrogen agonist, i. However, in cell culture experiments, resveratrol was found to act either as an estrogen agonist or as an estrogen antagonist depending on such factors as cell type, estrogen receptor isoform (ER. Most recently, resveratrol was shown to improve endothelial wound healing through an ER. By inhibiting the expression and activity of certain cytochrome P4. In contrast, increasing the activity of phase II detoxification enzymes generally promotes the excretion of potentially toxic or carcinogenic chemicals. Resveratrol has been found to increase the expression and activity of NAD(P)H: quinone oxidoreductase- 1 (NQO1) in cultured cells (2. II enzymes (2. 8). Inhibition of proliferation and induction of apoptosis. Following DNA damage, the cell cycle can be transiently arrested to allow for DNA repair or activation of pathways leading to cell death (apoptosis) if the damage is irreparable (2. Defective cell cycle regulation may result in the propagation of mutations that contribute to the development of cancer. Moreover, unlike normal cells, cancer cells proliferate rapidly and are unable to respond to cell death signals that initiate apoptosis. Resveratrol has been found to induce cell cycle arrest and/or apoptosis (programmed cell death) in a number of cancer cell lines (reviewed in 1. Inhibition of tumor invasion and angiogenesis. Cancerous cells invade normal tissue aided by enzymes called matrix metalloproteinases. Resveratrol has been found to inhibit the activity of at least one type of matrix metalloproteinase (3. To fuel their rapid growth, invasive tumors must also develop new blood vessels by a process known as angiogenesis. Resveratrol has been found to inhibit angiogenesis in vitro(3. Anti- inflammatory effects. Inflammation promotes cellular proliferation and angiogenesis and inhibits apoptosis(3. Resveratrol has been found to inhibit the activity of several inflammatory enzymesin vitro, including cyclooxygenases and lipoxygenases (3. Resveratrol may also inhibit pro- inflammatory transcription factors, such as NF. One of the earliest events in the development of atherosclerosis is the recruitment of inflammatory white blood cells from the blood to the arterial wall by vascular cell adhesion molecules (4. Resveratrol has been found to inhibit the expression of adhesion molecules in cultured endothelial cells (4. Inhibition of vascular smooth muscle cell (VSMC) proliferation. The proliferation of vascular smooth muscle cells (VSMCs) plays an important role in the progression of hypertension, atherosclerosis, and restenosis (when treated arteries become blocked again). Resveratrol has been found to inhibit the proliferation of VSMCs in culture (4. Resveratrol appeared to reduce VSMC proliferation via an ER. NO is needed to maintain arterial relaxation (vasodilation), and impaired NO- dependent vasodilation is associated with an increased risk of cardiovascular disease(4. Because physiological concentrations of resveratrol were found to stimulate e. NOS activity in cultured endothelial cells (5. Cardiovascular disease). Inhibition of platelet activiation and aggregation. Platelet aggregation is one of the first steps in the formation of a blood clot that can occlude a coronary or cerebral artery, resulting in myocardial infarction or stroke, respectively. Resveratrol has been found to inhibit platelet activation and aggregation in vitro(5. Biological activities related to neurodegenerative disease prevention and treatment. Stimulation of neurogenesis and microvessel formation. Age- related mood alterations and memory deficits result from a decrease in the function of the hippocampus in the elderly. Resveratrol was shown to stimulate neurogenesis and blood vessel formation in the hippocampus of healthy old rats. These structural changes were associated with significant improvements in spatial learning, memory formation, and mood function (5. Bauer, MD, FACSRadical Cystectomy, Ileal Conduit. Surgery Details. Contents. General information. Pre- operative instructions. Risks and Complications. Detailed Surgery Description. Family waiting instructions. Post- operative instructions. Printing tip: If you want to print only one portion of this entire document, you should be able to do this depending on your software. General Information. This procedure is commonly performed for aggressive or locally advanced Bladder cancer, for more background information about bladder cancer please see the link at. Bladder Cancer Information Surgical Therapy. Cystoprostatectomy. Bladder cancers that are no longer confined to the surface lining and have grown into surrounding tissue usually require surgical therapy. Specifically, Stage T2 to T3a tumors—that is, tumors that have invaded the muscle or fatty tissue around the bladder need surgical management. In men, a standard surgical procedure is Cystoprostatectomy (removal of the bladder and prostate) with pelvic lymphadenectomy (removal of the lymph nodes within the hip cavity). Bladder surgery, which usually involves removal of the seminal vesicles (semen- conducting tubes), can be performed in a manner that preserves sexual function in some men. In addition, new surgical methods of urinary diversion (re- routing of urine through a surgical channel) may eliminate the need for an external urinary appliance. Radical Cystectomy. In women with T2 to T3a tumors, a standard surgical procedure is Radical Cystectomy (cutting away of the entire bladder and associated tissues) with pelvic lymphadenectomy. Radical cystectomy in women includes removal of the uterus (womb), tubes, ovaries, anterior vaginal wall (front of the birth canal), and urethra (the tube that passes urine from the bladder out of the body). Preoperative radiation therapy may have some merit when combined with bladder surgery, although radiation therapy alone usually is unsuccessful. Urinary Tract Diversion. Until recently, most bladder cancer patients who underwent cystectomy (bladder removal) needed an ostomy (surgical creation of an artificial opening) and an external bag to collect their urine. Now, reconstructive surgical methods have been developed to replace the cancerous bladder. The continent urinary reservoir is the newest form of urinary diversion. With this technique, a piece of colon (large intestine) is removed and used to form an internal pouch to store urine. The pouch is specially refashioned to prevent back- up of urine into the ureters (one of two tubes that pass urine out of the kidneys and into the bladder) and kidneys. The patient—whether male or female—can urinate as before, without the need for an external bag or collection device. The urinary reservoir procedure is associated with some complications, such as bowel (intestine) obstruction, blood clots, pneumonia (lung inflammation), ureteral reflux (back- flow), and ureteral blockage. Ileal Conduit. The Ileal Conduit is a small urine reservoir that is surgically created from a small piece of the patient's bowel. During this procedure, the ureters are attached to one end of the bowel piece; the other end is brought out onto the surface of the body to make a stoma. The patient then attaches an external, urine- collecting bag to the stoma. This bag needs to be worn at all times. Complications of the ileal conduit procedure include bowel obstruction, urinary tract infection (UTI), blood clots, pneumonia, upper urinary tract damage, and skin breakdown around the stoma. Check any cold or pain medication bottles to make certain aspirin is not contained. See additional list at Blood Thinners. It will be ordered by your physician and it may require hospital admission the day before. INSULIN dose. DO NOT TAKE your morning INSULIN dose if you are driving a great distance the morning of surgery or if your surgery is scheduled for the afternoon. Use your asthma inhalers and bring them with you to the hospital. Pre- Operative Diet Instructions. Unless specifically instructed otherwise by your surgeon or anesthesiologist, patients of all ages must observe the following diet restrictions before surgery. Eight hours before the Scheduled Start of your Surgery: DO NOT EAT any solid foods, including juices with pulp (e. DO NOT DRINK full liquid, such as milk, cream, and jello. You may continue to drink up to eight ounces of clear liquids until SIX hours before the scheduled start of your surgery. Clear liquids include Water, clear juices (e. The reason for this is to prevent complications caused by nausea or vomiting while you are unconscious. Should you vomit while in the unconscious state, the risk exists that the vomit may enter into your lungs causing serious complications such as pneumonia. These complications may result in an extension of your hospitalization following your surgical procedure. It is for this reason patients are often instructed to have nothing by mouth after midnight the night prior to your operation unless otherwise instructed by an anesthetist. All adults are required to take a shower using either a Betadine or Hibiclens Surgical Scrub antibacterial soap. The reason is to remove as much bacteria from your skin as possible prior to your surgery. If you are allergic to these products please notify your physician or nurse. Perform your shower as follows. Generously lather your body, scrub well, and rinse. Give particular attention to the area were the incision will be made for your procedure. You may use any other antibacterial soap for the face. Please remove the nail polish from both index fingers. You may take a taxi car or shuttle if accompanied by a responsible adult who can stay with you after the driver departs. Metastatic work- up of liver function tests, CT scan of the pelvis and CXR were negative. The options for the urinary diversion are bowel conduit, bowel continent reservoir with catheterizable stoma, bowel orthotopic neobladder. The general risks of this procedure include, but are not limited to bleeding. Intensive Care Unit (ICU). Additionally, mentioned were the possible serious. Your anesthesiologist will discuss the risks and complications in more. Additional procedures may be necessary. You also understand that not every possible complication can be listed in this counseling note and additional risks are possible, although unlikely. Indications: Patient with invasive bladder cancer. Sample Procedure Dictation: Radical Cystoprostatectomy. Patient was given a continuous epidural anesthetic with supplemental general anesthesia. He was placed in the supine position and then was prepped and draped in the usual standard sterile fashion. A 2. 4 French Foley catheter was placed per urethra with good return of urine; balloon was inflated to 3. A midline incision was made from the above the umbilicus to the symphysis pubis coagulating all bleeders as they where encountered. The rectus fascia was divided the length of the incision, the pre- peritoneal space was identified, and the peritoneum was entered taking care to avoid any injury to the bowel. The umbilicus and the median umbilical ligament were isolated and dissected to the dome of the bladder leaving the posterior peritoneum wrapped over the bladder. We then placed a Buckwalter self- retaining retractor to expose the abdominal cavity. The small bowel was then retracted from the field with moist sponges and the White Line of Tolt was identified and incised along the lateral colonic gutters. This was carried superiorly to allow adequate expose of the bifurcation of the Aorta. The small bowel and the sigmoid colon were reflected from the field with moist sponges. These were inspected periodically to assure normal bowel integrity. The ureters were noted bilaterally and were isolated beyond the iliac arteries to just shy of the entrance into the posterior bladder. The common iliac and iliac lymph nodes were harvested without damage to the vasculature bilaterally and sent for permanent section analysis. The obturator lymph nodes were palpated. All nodes were normal in character and not sent for frozen section. We proceeded with obturator LN dissection, taking all nodes in the obturator fossa for permanent section analysis. This was accomplished without injury to the obturator nerve and vascular pedicle or the iliac artery and vein. All bleeders and lymphatics were bovied or clipped as they were encountered. We proceeded with incising the posterior peritoneal reflection into the Pouch of Douglas to gain access to the rectum and posterior bladder. This space was carefully developed to isolate the bladder with its attached vascular pedicles. The vascular pedicles were then clipped and bovied to avoid the posterior branch of the internal iliac artery. This division proceeded down to the inferior pedicle supplying the seminal vesicles and the prostate. The ureters were then clipped and cut with scissors just above the entrance into the bladder. The distal tips of the ureters were removed and sent for frozen section. The frozen section examination showed normal transitional mucosa bilaterally. The endopelvic fascia was then entered bilaterally to expose the puboprostatic ligaments. The dorsal vein complex was then isolated with the mixter clamp and #2- vicryl was used to tie the deep dorsal vein complex without division of the puboprostatic ligaments. The complex was then bovied and divided over the mixter clamp. Bleeding was controlled with a 0- chromic figure eight suture just above the urethra and below the pubis. The rectourethralis muscles were then divided and dissection of the prostate off the rectum proceeded without difficulty, the pedicles were clipped and divided exposing the posterior bladder neck and Denonvillier? The seminal vesicles were then isolated, clipped at the apex and divided. The remaining portions of the pedicles were then clipped and divided exposing the posterior bladder neck. The remaining attachments of the bladder to the rectum were taken down and the specimen removed for permanent section analysis.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. Archives
October 2017
Categories |