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C discount antabuse 250mg with visa, Markings for submental crease incision buy antabuse 500mg fast delivery, inferior border of mandible discount 250mg antabuse mastercard, and facial midline. D, Super- osteal dissection is carried out along the facial aspect of the inferior border. Eventually a capsule After insertion of the appropriate-size implant, the marked develops around the implant to help further stabilize it in midline of the implant is aligned with the patient’s previously place. Te wound is irrigated with sterile saline and then marked soft tissue chin midline. Te sively along the facial aspect of the inferior border with no subcutaneous layer is closed with 4-0 Monocryl. Steri-Strips has been verifed, the implant should be fxated to prevent can be placed across the incision site. Stable fxation may minimize long-term dressing is applied, as previously described (see Figure 29-2, mobility and bone resorption. A more extensive submental and neck pressure dressing screws are placed of midline to secure the implant in place. When Avoidance and Management of the foreshortened genial segment is advanced, it leaves a Intraoperative Complications greater defect along the inferior border that disrupts a smooth inferior jaw line (Figures 29-5 and 29-6). It can also deepen Genioplasty involving an osteotomy is technically more chal- the pre-jowl sulcus with remodeling and aging. To avoid this lenging than an implant and thus has the potential for more problem, the osteotomy should extend posteriorly to the frst complications. If the chin segment is positioned superiorly for bony contact, it creates an unesthetic contour defect along the inferior border and reduction of chin height. A B C Figure 29-6 A, Tis osteotomy is foreshortened; it does not extend back into the frst molar region. Note the resorption of the posterior wings of the genial segment over time, which contributes to notching of the inferior border of the mandible. Preoperative photographs (F and G) and 1-year postoperative photographs (H and I) showing an inferior border contour defect due to the fore- shortened osteotomy. C, An injectable, self-setting calcium phosphate cement can be used to fll craniofacial bony defects that are not intrinsic to the stability of the bony struc- C ture. It is important to review segment advancement or to graft particulate hydroxyapatite radiographs carefully before surgery to assess the position of along the inferior border defect at the time of surgery (Figure the nerve. Tis can occur if the nerve runs low in sected, a neurorrhaphy procedure using 7-0 Nurolon or relation to the inferior border of the mandible and the situ- Prolene suture can be attempted. However, it can be difcult ation is not appreciated preoperatively and adjusted for to free enough of the proximal and distal segments for passive during surgery. Tis can occur with undue trauma to the foor of the mouth muscles during osteotomies. Also, the surgeon must avoid overinserting the reciprocating saw through the lingual cortex. If a hematoma is noted, it should be evacuated and the source of bleeding should be controlled. Injection of a local anesthetic with vasoconstrictor or placement of a hemo- static agent (e. To avoid chin ptosis or a “witch’s chin” deformity, the surgeon should avoid excessive stripping of the mentalis muscle. Also, time should be taken to adequately reapproxi- mate the mentalis muscle when closing. Postoperative Considerations Prophylactic antibiotics and steroids typically are given pre- operatively. Continued postoperative antibiotics and steroids can be considered for a short period. Te patient should maintain a soft, nonchew diet for 1 to 2 weeks and then advance as tolerated. Testing should include two- point discrimination, static light touch, brush directional stroke, pin prick, and thermal discrimination. If there is per- sistent anesthesia, hyperesthesia/dysesthesia, or troublesome hypoesthesia, the patient should be ofered referral for micro- 16 neurosurgical repair. If this creates an unacceptable cosmetic result, Figure 29-8 A, Medpor geniomandibular groove implant placed it can be corrected by grafting or implant placement. B, Mittelman apatite is a good grafting material because of its biocompat- Pre Jowl-Chin implant augments the pre-jowl sulcus without increasing chin projection. If there is incomplete union of the Avascular necrosis also has been reported when the chin is osteotomy gap with associated pain, reoperation may be indi- advanced as a free graft. A larger osteotomy gap should be grafted to help scar tissue formation along the osteotomy gap. Tese include displacement of the implant, resorption the commonly used extended chin implant design. Local if the implant is not secured at the inferior border by either wound care and aggressive antibiotic therapy usually are not suturing to the periosteum or securing with bone screws, it successful in resolving this problem. In most situations the 3 is more prone to displace of the thicker inferior border and implant must be removed. It is also important to maintain a on the need for proactive treatment of surrounding skin confned dissection and pocket along the inferior border. In Miloro M, editor: Peterson’s principles mental nerve injuries, J Craniofac Surg 7:297, thia with consideration of genioplasty. In alveolar neurovascular canal in relation to Surg Oral Med Oral Pathol 10:677, 1957. Ritto Armamentarium #15 Scalpel blade Handpiece, #701, #702, #703 burs Obwegeser retractors (up, down, and Appropriate sutures Kocher’s forceps ramus) Bite block Local anesthetic with vasoconstrictor Periosteal elevator Chisels (thin spatula and large ones) Mallet Smith spreader Curved hemostats Metzenbaum scissors Weider retractor Dietrich tissue forceps Minnesota retractor Wire cutter Electrocautery Needle holder Wires (24 and 26 gauge) Frasier suction tip Obwegeser channel retractor 11 In 1974 MacIntosh was the frst to describe the total History of the Procedure mandibular subapical osteotomy. In this description, the author recommended an extraoral approach to perform the Surgeries of the alveolar segments were probably the frst vertical bone cut behind the last molar in cases of microgna- techniques described to correct occlusal deformities. In 1980 Epker 2 12 and Wassmund were the pioneers of the technique, and and Wolford published a book that presented great improve- 3 4 other surgeons, such as Bell and Dann and Kent and Hinds, ments on this technique, combining a sagittal osteotomy with established details regarding indications and management. Most important, Bell and Levy,5 Castelli et al,6 and Hellem 7 and Ostrup studied the blood supply to the osteotomized 8 segment. Epker also pointed out some important details that must be taken into consideration to avoid tooth loss and Indications for the Use of the Procedure avascular necrosis, which he considered the most devastating complications. Mandibular subapical osteotomies are not the most common Hofer9 and Köle10 were probably the frst to describe the choices to treat patients with dentofacial deformity. Tey recom- the anterior subapical osteotomy is a very versatile technique mended operating the models before actual surgery to achieve that allows the osteotomized segment to be moved in difer- favorable occlusion and to fabricate the surgical splint. It is possible to set the anterior segment proposed a technique to treat the prognathism with the inci- backward, forward, upward, and downward, depending on sion located in the buccal gingiva. On the other hand, Köle posi- According to Bell and Legan and Wolford and Moen- tioned the anterior incision in the vestibule so that the mobi- ning,14 the mandibular anterior subapical osteotomy may lized segment remained covered by mucosa and the nerve be indicated to (1) level the occlusion, (2) produce antero- remained sound.

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Biosafety Level 2 conditions apply for workers handling specimens order antabuse on line amex, because most clinical specimens have spores in the vegetative state that are not easily transmitted generic antabuse 500mg mastercard. The presence of large gram-positive rods in short chains that are positive on India ink staining is considered presumptive of B cheap antabuse online mastercard. Nasal swabs are only useful for determining exposure in large groups of exposed persons; they have no role in individual diagnosis. The test can be completed in less than 1 hour and is available to hospital and commercial laboratories by the manufacturer [56]. Treatment Owing to the fulminant course of systemic anthrax, prompt initiation of therapy is essential for survival. Meningitis is a common complication of systemic anthrax and must be either excluded by lumbar puncture or treated empirically [57]. Systemic anthrax should be divided into meningeal and nonmeningeal disease for purposes of initial therapy. Once meningitis has been excluded, either a quinolone or a carbapenem may be used; combination therapy is not necessary in that setting. Carbapenems may be replaced with intravenous penicillin G or ampicillin once penicillin susceptibility has been confirmed. Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial drug course of 60 d from onset of illness. Systemic anthrax includes anthrax meningitis; inhalation, injection, and gastrointestinal anthrax; and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck. However, it may be used in combination with other antimicrobial drugs on the basis of its in vitro synergy. Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial drug course of 60 d from onset of illness. Systemic anthrax includes anthrax meningitis; inhalation, injection, and gastrointestinal anthrax; and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck. There are limited data regarding treatment of pregnant women for anthrax, but anthrax infection is associated with both maternal and fetal death. Patients who are pregnant, postpartum, or lactating should therefore receive the same treatment as nonpregnant adults with only a few exceptions. Fluoroquinolones (ciprofloxacin, levofloxacin, or moxifloxacin) should be given to pregnant women for both postexposure prophylaxis and treatment unless otherwise contraindicated. Doxycycline is relatively contraindicated in pregnancy and should only be considered if ciprofloxacin is unavailable or absolutely contraindicated. The use of systemic corticosteroids has been suggested for meningitis, severe edema, and airway compromise [58]. Cutaneous anthrax with systemic involvement; significant edema; and lesions of the head and neck should be treated similarly. Uncomplicated cutaneous anthrax can be treated with oral ciprofloxacin or doxycycline for 7 to 10 days; however, owing to the possibility of concomitant inhalational exposure, a 60-day course is recommended [59,60]. A review of anthrax cases in adults from 1900 to 2004 noted that fulminant inhalational anthrax is often fatal despite advances in medical care. Early diagnosis, initiation of therapy and drainage of all effusions, improved survival and is pivotal for decreasing mortality in inhalational anthrax [54]. Similarly, a review of anthrax cases in children from 1900 to 2005 shows that early diagnosis and treatment of all forms of anthrax are critical for improved survival of children [61]. The clinical algorithm addresses four decision points where resource limitations might impact clinical management during an anthrax mass- casualty incident. The first decision point involves diagnostic evaluation of anthrax meningitis, which is necessary to determine optimal antimicrobial therapy. The second decision point involves treatment regimens of combination intravenous antimicrobial therapy. The fourth decision point involves the identification and drainage of fluid collections, which have been associated with a survival benefit. Clinicians may choose to administer a second oral antimicrobial for patients with nonspecific symptoms of anthrax who do not meet criteria for hospitalization. Patients with meningitis or in whom meningitis cannot be excluded should be treated aggressively and receive antitoxin even if an antitoxin shortage exists. Clinicians experienced with management of effusions should assess for significant fluid collections and drain as possible under the current standard of care. High-dose penicillin or ampicillin may be an acceptable alternative for 60 days in patients who are allergic or intolerant to the recommended antibiotics [56]. The main reasons for discontinuing therapy were gastrointestinal or neurologic side effects (75%) or a low perceived risk (25%). The vaccine consists of supernatant material from cultures of a toxigenic, nonencapsulated strain of B. There are currently three products available, to be given in combination with antibacterial therapy: raxibacumab, a recombinant monoclonal antibody directed against the B. The impact of such an attack would probably linger for several weeks to months because of disease relapses [71]. As a biologic weapon, the organism would most likely be dispersed as an aerosol, and cause mass casualties from an acute febrile illness that may progress to severe pneumonia [46,72]. Epidemiology Tularemia occurs throughout the northern hemisphere, with highest incidence in Russia and Scandinavian countries. A large outbreak of tularemia in 2003 along with small summer outbreaks between 1995 and 2005 in Sweden suggests environmental sources clustering around recreational areas [74]. An outbreak of tularemia on Martha’s Vineyard, Massachusetts, during the summer of 2000 was associated with lawn mowing and brush cutting [75]. A water-borne outbreak resulting in 21 cases of oropharyngeal and five cases of glandular tularemia was reported in the Republic of Georgia [76]. Eventually, apoptosis of the macrophage occurs with the subsequent release of organisms resulting in secondary involvement of the local lymph nodes and bacteremia [70]. Following inhalational exposure, hemorrhagic airway inflammation may progress to pneumonia, pleuritis, and pleural effusion. Clinical Features the clinical manifestations of tularemia depend on the site of entry, exposure dose, virulence of the strain, and host immune factors. Syndromes associated with tularemia are classified as primary pneumonic, typhoidal, ulceroglandular, oculoglandular, oropharyngeal, and septic. After an incubation period of 3 to 6 days (range, 1 to 25 days) following a vector bite or animal contact, patients present with high fevers (85%), chills (52%), headache (45%), cough (38%), and myalgias (31%). At the site of inoculation, a tender papule develops that later becomes a pustule and ulcerates as shown in ure 130. Exudative pharyngitis and tonsillitis may develop following ingestion of contaminated food or inhalation of the aerosolized organism. The pneumonic form may also occur as a result of hematogenous spread from other sites of infection or following oropharyngeal tularemia. After inhalational exposure, constitutional symptoms, such as fever and chills, typically precede the onset of respiratory symptoms.

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An especially when exposures are widespread or agent may be assigned to this category if it clearly the cancer data are consistent with difering belongs antabuse 500mg low cost, based on mechanistic considerations buy antabuse 250 mg overnight delivery, to interpretations buy antabuse 250mg free shipping. Tis category is used for agents for which there is evidence suggesting lack of carcinogenicity 28 Preamble in humans and in experimental animals. Proceedings of a consensus experimental animals, consistently and strongly conference. Te sci- ence and practice of carcinogen identifcation and (e) Rationale evaluation. A comparison in experimental animals, and mechanistic and of tests for trend with historical controls in carcinogen other relevant data. Use of historical provided, together with their scientifc rationale control data in carcinogenicity studies in rodents. Implication References of nonlinear kinetics on risk estimation in carcino- genesis. Metabolic Carcinogenicity of Mixtures and Groups of Chemicals Polymorphisms and Susceptibility to Cancer. Te use of short- and medium-term tests for carcinogens and data on genetic efects in carcinogenic hazard evalua- tion. Guidance Notes for Analysis and Evaluation of Chronic Toxicity and Carcinogenicity Studies (Series on Testing and Assessment No. Guidelines for simple, sensitive signifcance tests for carcinogenic efects in long-term animal experiments. Testing for increased carcinogenicity using a survival-adjusted quan- tal response test. Multistage models of carcinogenesis: an approximation for the size and number distribution of late-stage clones. Introduction specifc therapeutic usage, a major aspect of the use of drugs worldwide involves herbal products. Use of the term “herbal medicine” carcinogenic hazard to humans of exposure to 14 is arbitrary in many contexts. None wide variety of pharmaceutical drugs, that is, of these, except hydrochlorothiazide, have been agents recognized as having a particular phar- previously evaluated by the Working Group. Te therapeutic beneft of Among the agents that are known to cause such herbal products may have been recognized cancer in humans specifcally, there are several in certain communities for centuries. In respect of specifc composition may vary from country to country chemical carcinogens, the number of agents clas- and within countries, even when diferent prod- sifed as carcinogenic to humans that are thera- ucts bear the same name. In addition, the use of peutic drugs is second only to the number of particular herbal products may vary markedly agents that have been identifed in the context of between countries and between communities occupational exposures. Exposure to herbal products Monographs are specifed with reference to indi- vidual components known to occur in particular and pharmaceuticals plants, as is the case for pulegone and digoxin. Unlike tions to the extent that they involve components single-entity pharmaceuticals, plants contain (e. In addition, raw materials are inher- for primidone) of agents considered in the present ently variable because their chemical compo- volume. In the 1970s, botanicals were products may not match that of the parent plants, largely sifed, cut, or powdered plant material and products frequently contain multiple botan- in the form of a tablet, capsule, tea, or tincture. More recently, herbal products are ofen derived Discussions of exposure to natural products from intensely processed, carefully controlled can be complicated by several factors. Te frst organic extracts of plant material that have been is the market category in which the product spray-dried onto a solid carrier or diluent and falls. Herbal products can be sold as conven- then formed into a hard or sof capsule or tablet. Unfortunately, most standardized sify these as natural health products, therapeutic extracts focus on one or a handful of the thou- goods, phytomedicines, herbal medicinal prod- sands of constituents of the whole plant, so that ucts, traditional medicines, or conventional even standardized extracts that are created using drugs). Attempts to compare herbal products cally the carcinogenicity of complex mixtures, by viewing the entire phytochemical fngerprint may be addressed by consideration of informa- are beginning to appear, but these techniques tion concerning the mixture, and its variability have not yet had time to have an impact on the in diferent contexts, and also by consideration market or the publicly available scientifc litera- of information concerning biologically active ture (van Beek & Montoro, 2009). Information Tere are several advantages to using such relevant to possible carcinogenicity may be most highly processed raw materials. Tese include adequately addressed with reference either to the the ability to produce dosage forms that are more mixture or to the active component(s). Terefore, uniform in their composition, and the ability to some Monographs in the present volume are spec- preferentially concentrate the desirable constitu- ifed with reference to the plant itself, i. Aloe ents of a plant while leaving behind undesirable vera, Ginkgo biloba, goldenseal, or kava. Because products are frequently 32 General remarks referred to generically by the name of the plant tested from among dozens or hundreds of prod- in marketing and consumer-use surveys, it is ucts with similar or identical names but widely difcult to diferentiate between exposure to divergent compositions remains a major obstacle. In countries where there is commercial products are very diverse in terms pre-market review and product licensing, prod- of processing, composition, and intended use. Tis is a recur- and similarly named products marketed in this ring theme for all discussions on herbal products. Having better information on patterns of sition of herbal products that are available to use and on product composition would provide consumers, problems in interpreting published a means to prioritize the herbal products consid- scientifc studies of herbal products have been ered in this volume for such activities as policy reported. Tey noted that only 12 (15%) of the studies accessible than that on herbal products, limita- reported any kind of quantitative chemical anal- tions remain. In addition, only 40 of the studies published studies indicated that patterns of adher- (49%) provided the Latin binomial name of the ence and persistence are suboptimal for medica- study material, only 8 (10%) identifed the part tions used to manage or treat chronic conditions. To prevent such must be made using means similar to those used problems in future studies, Swanson (2002) and to estimate exposure to herbal products (e. Although not widely available or widely studies adhere to or surpass the above guide- accessible, such data for over-the-counter drugs lines when selecting test articles or designing is more informative than for herbal products sold studies, it would be useful if these guidelines as foods or dietary supplements because drug became standard practice, as the reproducibility products with similar names are required to be and reliability of safety studies would be greatly similar in composition. In some be much more accurately measured for pharma- instances, studies may generate epidemiological ceuticals than for other agents, and therapeutic data that refer to the use of particular classes of doses used in humans are ofen closer to those drug, rather than particular individual drugs. Nonetheless, Interpretation of such data to infer efects attrib- characterizing the true nature of exposure to utable to particular drugs, such as pioglitazone, drugs in relation to carcinogenicity is compli- rosiglitazone and hydrochlorothiazide, and cated by the variability in adherence to drugs the small number of available epidemiological and their varying patterns of use – intermittent studies, may render this task difcult or almost versus continuous. In the specifc case of epidemio- the Working Group concerning occupational or logical fndings in relation to pharmaceutical environmental circumstances of exposure to the drugs, it is self-evident that the exposed indi- agents evaluated in this volume. At one extreme, increased risk of cancer in such individuals may populations using drugs be caused by the drug they have received. At the other extreme, an association between increased Te Monograph on digoxin exemplifes the risk of cancer and use of a particular drug may complications in drug nomenclature that may be totally independent of causality and arise for arise due to diferences in professional prac- several reasons: because patients with a particular tice and disciplines (e. As explained therein, the term patients with a particular disease are more liable “digitalis” as used with reference to chemical than the community in general to be exposed to specifcations may refer to a plant extract, while an independent factor that causes or is correlated the same word in a medical therapeutic context with increased risk of cancer; or because the may refer to a particular category of agents (e. Such incongruities not only prompt the use of a drug, which can subsequently contribute to potential misunderstanding of be suspected as its cause. An additional problem data; in an immediate sense, they may compli- is that patients commonly receive more than one cate adoption of a particular term as the appro- drug, and determination of the carcinogenicity priate identifcation of the subject of a Monograph of any single drug may be difcult. Considerations beyond hazard scientifc fndings identifcation While historically, multiple studies of carcino- Many (if not most) regulatory decisions genicity in experimental animals may have been concerning putative carcinogens necessitate conducted on a single test agent in several inde- consideration not only of perceived hazard, but pendent laboratories, today the massive expense also of potential beneft. It is crucial, therefore, involved in rigorous testing for carcinogenicity that regulatory decisions afecting drug availa- in experimental animals ofen means that only bility include assessment not only of potential one or two well conducted studies of carcino- carcinogenicity (and other adverse efects), but genicity (ofen in one strain of rat and/or one also of the health benefts derived from their strain of mouse, and typically involving males usage.

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Jenkins and coworkers (1975) reported the hypocholesterolemic effect of guar gum order discount antabuse on-line, which is often added to foods order antabuse australia. Since 1975 there have been a number of studies with guar gum supplementation and findings of an 11 to 16 percent reduction in serum cholesterol concentration (Anderson and Tietyen-Clark order antabuse online, 1986; Penagini et al. Blake and coworkers (1997) evaluated the effect of depolymerized guar galactomannan on fasting plasma lipid concentrations in volunteers with moderately raised plasma cholesterol. In addition to decreasing blood cholesterol concentrations, guar gum has also been shown to decrease concentrations of triacylglycerols (Bosello et al. Viscous fibers, such as pectin and guar gum and those present in oat products and beans, produced significant reductions in glycemic response in 33 of 50 studies (66 per- cent) as reviewed in Wolever and Jenkins (1993). This is in contrast to only 3 of 14 studies conducted with insoluble fiber (21 percent). In addition, the provision of 30 g/d of guar gum decreased fasting blood glucose con- centration and increased insulin sensitivity (Landin et al. In a dose–response study to determine the amount of guar gum needed to decrease postprandial glycemia and insulinemia, guar gum was supplied at 0, 2. A reduction of 209 mU/min/L in the integrated insulin curve was estimated for every 1 g of guar gum incorpo- rated into the biscuit. The addition of 10 g/d of guar gum to a test meal generated an overall decrease in blood glucose concentrations in both normal (n = 5) and diabetic (n = 6) individuals (Goulder et al. In a study with 18 type 2-diabetic patients, 5 g of guar gum granules or 5 g of wheat bran were sprinkled over food at each main meal for 4 weeks (Fuessl et al. There was a 50 percent reduction in the incremental area under the postprandial glycemic curve with the guar gum. Mean fasting plasma glucose and glycosylated hemoglobin concen- trations were lower after treatment with guar gum compared with the wheat bran control. In one study with type 2 diabetics with near-normal fasting plasma glucose concentrations, 15 g/d of guar gum did not reduce the excessive postprandial glycemic response (Holman et al. Although the mechanism for improved glycemic response seen with guar gum in most studies is not entirely clear, guar gum has been shown to increase C-peptide response over time, thus suggesting enhanced insulin secretion by guar gum (Groop et al. When the standard glucose test was performed after ingestion of 15 g/d of guar gum, improved glucose toler- ance was observed in all but one pregnant women. In addition, guar gum generated significant reductions in mean serum glucose concentrations at 1, 2, and 3 hours after feeding (Gabbe et al. A few studies have demonstrated an increase in fecal bulk and increased stool frequency upon the ingestion of inulin or oligofructose. Fecal weight was increased after consuming 15 g/d of inulin or oligo- fructose (Gibson et al. After 2 to 6 weeks of treatment with 20 g/d of fructo- oligosaccharides or placebo, symptoms of irritable bowel syndrome improved more in the placebo group than in the fructooligosaccharide group; however, there was no difference between the groups after con- tinuous treatment for 12 weeks. Studies on the effect of inulin or oligofructose ingestion on plasma lipid concentrations have provided mixed results. Significant reductions in plasma triacylglycerol concentrations occurred with the intake of 10 g/d of inulin, particularly in those individuals with a baseline triacylglycerol concentration greater than 1. The ingestion of 9 g/d of inulin signifi- cantly reduced plasma total cholesterol and triacylglycerol concentrations in young men (Brighenti et al. In young, healthy males, 15 g/d of nondigestible oligosaccharides (inulin or fructooligosaccharides) did not decrease blood lipids or affect glucose absorption compared to controls (van Dokkum et al. A placebo-controlled parallel study showed that a daily intake of 10 g of inulin significantly reduced fasting insulin concentrations (Jackson et al. Fasting blood glucose concentrations were significantly reduced by 15 mg/dL in type 2 diabetics who were fed 8 g/d of fructooligosaccharides (Yamashita et al. Daily intake of 20 g of fructooligosaccharides significantly decreased basal hepatic glucose production (Luo et al. No difference, however, was observed in the incremental area under the curve for glucose when indi- viduals were fed 50 g of a rice-based cereal containing 0 or 9 g of inulin (Brighenti et al. An important effect of inulin intake is considered to be the production of Bifidobacteria. Bifidobacteria contain high amounts of β-fructosidase, which are specific for the β-(1,2) bond present in inulin and oligofructose. A number of studies in humans have shown that the ingestion of fructooligosaccharides leads to an increase in fecal Bifidobacteria (Bouhnik et al. Bifidobacteria have been shown to promote beneficial health effects in animals (Grizard and Barthomeuf, 1999); however, potential beneficial effects in humans are not well understood. Extracted β-glucans are highly fermentable and therefore their contribution to fecal bulk is minimal (McBurney, 1991). This may contribute, in part, to the lack of an effect in preventing constipation. Oat bran increases stool weight by supplying rapidly fermented viscous fiber to the proximal colon for bacterial growth (Chen et al. In one study, oat gum supplementation (9 g/d of β-glucan) did not significantly decrease serum total cholesterol concentration compared to the placebo, leading the authors to conclude that the cholesterol-lowering capacity of oat gum in healthy young men is weak (Beer et al. In contrast, when hyper- cholesterolemic individuals were fed oat gum providing 5. The long-term effects of such products were tested in men with type 2 diabetes (Pick et al. In one study, individuals with type 2 diabetes were fed meals containing wheat farina, wheat farina with oat gum, or oat bran (Braaten et al. Both the oat bran and wheat farina with oat gum meals reduced the postprandial rise in plasma glucose and insulin concentrations compared to the wheat farina meal without the oat gum. This is an example of the extracted form of oat bran (Functional Fiber) having a similar effect to the native form (Dietary Fiber). Oat gum has also been compared to guar gum with respect to glucose and insulin responses after an oral glucose load in healthy, fasting individuals (Braaten et al. In this study, the glucose and insulin responses to the oat and guar gum meals were nearly identical. Hallfrisch and colleagues (1995) studied glucose responses in 16 women and 7 men with moderately high cholesterol concentrations who supplemented their normal diets with oat extracts in which either 1 or 10 percent viscous β-glucans were added. Glucose responses were reduced at both the 1 and 10 percent β-glucan supplementation level. In a meta-analysis of approximately 100 studies on stool weight changes with various fiber sources, investigators were able to calcu- late the increase in fecal weight due to fiber ingestion (Cummings, 1993). This meta-analysis concluded that pectin ingestion leads to an increase of about 1. In a randomized crossover study designed to compare the effects of pectin (12 g/d), cellulose (15 g/d), and lignin (12 g/d) on stool characteristics in healthy volunteers, pectin did not alter transit time or increase 24-hour stool wet weight, whereas cellulose decreased mean stool transit time and increased mean wet stool weight (Hillman et al. For example, in a 16-week, double-blind crossover study, grapefruit pectin supplementa- tion decreased plasma cholesterol concentration by 7.