A sclerosant with astringent properties developed in China for oesophageal varices: comparison with ethanolamine oleate and polidocanol

BACKGROUND

Xiao zhi ling (XZL), which consists of Chinese nutgalls and aluminium potassium sulphate, is used as a local injection for the treatment of internal haemorrhoids in China. It is also used for endoscopic sclerotherapy of oesophageal varices. To date, however, it has not been compared with other sclerosants with regard to its safety and efficacy.

METHODS

In the present study, the effect on the endothelium and the haemolytic and thrombosing effects of XZL were compared with those of 5% ethanolamine oleate and 1% polidocanol, using an endothelial cell line and red blood cells taken from rats and the dorsal marginal ear vein of rabbits. In addition, XZL was injected into the area surrounding varices in rats and its efficacy was studied endoscopically and histologically.

RESULTS

Xiao zhi ling reduced the size of varices in rats after causing severe damage in the injected region. Compared with the other two sclerosants, however, XZL had little effect on the endothelium and was the least haemolytic compound. Furthermore, XZL did not cause thrombosis in the injected vein of a rabbit.

CONCLUSIONS

These results suggest that XZL is another type of sclerosant with astringent rather than detergent properties. This compound should be used to treat oesophageal varices by paravariceal injection in smaller doses than 5% ethanolamine oleate and 1% polidocanol.

Sclerotherapy for leg telangiectasia--a blinded comparative trial of polidocanol and hypertonic saline

BACKGROUND

Hypertonic saline (HS) and polidocanol (POL) have been in use around the world for sclerotherapy of telangiectasia for many years. However, despite numerous articles in the literature extolling the virtues of their individual use, few studies scientifically compare their relative efficacies.

OBJECTIVE

To compare, in a statistically significant number of female patients, the relative efficacy of hypertonic saline and polidocanol as sclerosants of leg telangiectasia and reticular feeding veins, using each patient as her own control.

METHODS

Eighty-one women with roughly matching leg telangiecasia were treated with sclerotherapy. One leg was injected with 20% saline/2% lignocaine, the other with 1% polidocanol, with the patients blinded as to the sclerosant used for each leg. Assessment of percent reduction of vessels, and the complications of matting and hemosiderin staining was conducted at 2 months by 3 methods: the patient's satisfaction, the treating physician's evaluation, and blinded assessment of before and after photographs.

RESULTS

There was no statistically significant difference between HS and POL treated legs when assessed clinically or photographically. However, POL caused more staining and matting, and despite patients finding HS more painful at injection, patient satisfaction at follow-up was higher with the HS treated leg.

CONCLUSION

20% HS and 1% POL have equal efficacy in sclerosing leg telangiectasia and reticular feeding veins. POL causes more adverse sequelae, although these may be related to the solution concentration.

Combined ligation and sclerotherapy versus ligation alone for eradication of bleeding esophageal varices: a randomized and prospective trial

BACKGROUND AND STUDY AIMS

A number of trials have been reported in which a combination of ligation and sclerotherapy was compared with ligation alone, or with sclerotherapy alone. The present trial was carried out to assess whether the combined therapy might achieve more rapid eradication of bleeding esophageal varices.

PATIENTS AND METHODS

One hundred and three patients with either active bleeding or stigma of recent bleeding from esophageal varices were randomly assigned to receive ligation plus sclerotherapy, or ligation alone. Ligation was performed with the technique introduced by Stiegmann. Sclerotherapy was carried out using low-volume (1 ml) 1% aethoxysclerol, which was injected into varices proximal to each ligature. Further treatment sessions were held seven days later, and then at two-week intervals, until eradication of the varices was achieved. Endoscopic follow-up examinations were carried out at three-month intervals, or immediately if there was any recurrent bleeding. The mean follow-up period was 14 months.

RESULTS

There were no significant differences between the groups of patients compared with regard to the number of sessions required to eradicate the varices (2.4 +/- 0.7 in the combined group, and 2.3 +/- 0.7 in the ligation group; p>0.05). No significant differences were found between the groups with regard to recurrent bleeding (Fp = 2.882; p > 0.05). Three cases of recurrent bleeding (6%) from treatment-induced ulcers and two cases of recurrent bleeding (4%) from duodenal ulcers were observed with the combined therapy and ligation, respectively. No significant differences in the mortality were found between the groups (Fp = 1.145; p>0.05). Two percent of patients in the ligation group died due to bacterial peritonitis.

CONCLUSION

Since ligation combined with low-volume sclerotherapy did not reduce the time required for variceal eradication, it can be concluded that the combined therapy is not superior to ligation alone. This mode of endoscopic therapy for the treatment of bleeding esophageal varices is therefore not recommended.

Variceal ligation compared with endoscopic sclerotherapy for variceal hemorrhage: prospective randomized trial

BACKGROUND

To evaluate the safety and efficiency of variceal ligation compared with endoscopic sclerotherapy, 88 patients with cirrhosis with recent variceal bleeding were randomized to undergo either treatment.

METHODS

Sclerotherapy was performed using ethanolamine and polidocanol injection at 1, 2, and 3 weeks and every 3 weeks thereafter. The Stiegmann-Goff device was used for variceal ligation at the same intervals.

RESULTS

The rate of variceal eradication was the same for both groups, but eradication was accomplished sooner in patients undergoing variceal ligation (5.3+/-1.6 vs. 6.6+/-2.4 endoscopic sessions, p < 0.05) and with fewer complications (19 vs. 6, p < 0.005). The rate of recurrent bleeding was lower in patients treated by ligation (31% vs. 50%, p < 0.05). After eradication, variceal recurrence was more frequent in patients treated by variceal ligation at 1 and 3 years (47% and 92% vs. 23% and 55%, p < 0.01). Portal hypertensive gastropathy was significantly worse in the patients who had variceal ligation (17 patients vs. 6, p < 0.01). Survival and treatment failure were similar in both groups.

CONCLUSIONS

Variceal ligation was superior to sclerotherapy in terms of the rate of recurrent bleeding and the occurrence of complications but worse with respect to recurrence of varices and the evolution of portal hypertensive gastropathy. Long-term follow-up studies are required to find out whether there are deleterious effects of variceal ligation.

Embolia cutis medicamentosa of the foot after sclerotherapy

Typically, embolia cutis medicamentosa is reported after intramuscular injections of drugs. We describe a case of embolia cutis medicamentosa after sclerotherapy of intracutaneous veins of the foot with a polidocanol solution of 1%. Under therapy with intravenous alprostadil, pentoxifyllin, internal steroids and anticoagulation with heparin, the lesions healed completely without necrosis.

[Embolia cutis medicamentosa (Nicolau syndrome) after intra-articular injection]

Embolia cutis medicamentosa (Nicolau Syndrome) is a very rare complication of intramuscular injections which presents with extensive necrosis of the injected skin area. Intra-arteria and/or para-arterial injections after prior perforation of certain vessels are discussed as possible pathogenetic mechanisms. We describe the occurrence of embolia cutis medicamentosa after intra-articular injections into the knee.

Endoscopic variceal ligation is a sufficient procedure for the treatment of oesophageal varices in patients with hepatitis C liver cirrhosis: comparison with injection sclerotherapy

AIMS

Endoscopic variceal ligation (EVL) is a recently developed alternative to endoscopic injection sclerotherapy (EIS) for the treatment of oesophageal varices. Endoscopic variceal ligation and EIS were compared in an attempt to clarify the efficacy and safety of EVL for patients with cirrhosis due to hepatitis C.

METHODS

Endoscopic variceal ligation was performed in 60 patients and EIS in 30. Varices were eradicated in all patients by EVL and 87% (26 out of 30) by EIS.

RESULTS

There was no significant difference between EVL and EIS in relation to the incidence of bleeding and the 5 year survival rate after treatment. There were no severe complications except mild substernal pain after EVL, while pulmonary embolism occurred in one patient receiving EIS.

CONCLUSIONS

Endoscopic variceal ligation is a safe and effective technique for eradicating oesophageal varices in patients with hepatitis C cirrhosis.

Purification of ethanolaminephosphotransferase from bovine liver microsomes

CDP-ethanolamine:diacylglycerol ethanolaminephosphotransferase (EC 2. 7.8.1) has been purified to electrophoretic homogeneity and in a catalytically active form from bovine liver microsomes. The purification method is based on the high hydrophobicity of the protein whose charged sites appear to be masked from the interaction with the chromatographic stationary phases when membranes are solubilized with an excess of non-ionic detergent. The isolated protein has a molecular mass of about 38 kDa, as estimated by SDS-PAGE mobility, and exhibits both ethanolaminephosphotransferase and cholinephosphotransferase activities. Evidence is given that both activities are Mn2+-dependent and that the same catalytic site is involved in cholinephosphotransferase and ethanolaminephosphotransferase reactions. Mg2+-dependent CDP-choline:diacylglycerol cholinephosphotransferase (EC 2.7.8.2) is completely inactivated during the solubilization and purification steps.

Long cotton wool rolls as compression enhancers in macrosclerotherapy for varicose veins

BACKGROUND

Macrosclerotherapy in combination with compression has proven to be safe and effective in the treatment of varicose veins. Local compression is increased by pads, according to Laplace law. Firm rolls of cotton wool are fixed over the course of the entire vein to increase local compression and to reduce complications. Additional compression is given by a combination of a class I (daytime and nighttime) and class II (daytime only) medical compression hosiery.

PURPOSE

To evaluate the effectiveness and side effects of sclerocompression therapy with cotton wool rolls in combination with medical compression hosiery.

METHOD

Prospective study with 100 patients (120 legs) with primary varicose veins, which are treated with polidocanol as sclerosant with the empty vein technique. Immediately after the injection, a long cotton wool roll is placed over the entire vein and fixed. Additional compression is obtained with class I and class II medical compression hosiery. The interface pressure on the skin, just under the cotton wool roll, is measured on 12 legs with the aid of an interface pressure measuring instrument (Oxford Pressure Monitor).

RESULTS

Good sclerosing results are obtained in all patients. Side effects are classified as early and late. In 16 patients, minor side effects which needed no treatment are observed. In only 3 cases (2.5%), intravascular blood clots (2) and phlebitis (1) needed incision and expression. The mean interface pressure of all measuring sensors under the cotton wool roll is 84 mm/Hg (68 to 122 mm/Hg).

CONCLUSION

This study proves the high effectiveness of a cotton wool roll compression right at the place of treatment. By using these long cotton wool compression rolls, the compression part of sclerocompression therapy becomes more effective and much easier to perform.

Enhanced in vivo airway gene transfer via transient modification of host barrier properties with a surface-active agent

Effective adenoviral gene therapy requires efficient viral vector entry into epithelial cells. Injured airway epithelia display enhanced gene transfer, reflecting in part increased vector access to protected cell populations and/or protected basolateral membranes. We tested whether adenoviral gene transfer is enhanced by modification of the epithelial barrier in mouse nasal airways with a nonionic detergent (polidocanol, PDOC). In C57BL/6 mice, 1.6 x 10(9) PFU of Ad5CMV LacZ (AdLacZ) instilled into the right nostril produced negligible gene transfer to the nasal epithelium 2 days after dosing, but significant, dose-dependent increases in gene transfer were achieved by pretreatment with PDOC. Permeation of the electron-dense tracer lanthanum into the intercellular junctions of PDOC (0.1%)-treated murine nasal epithelium, but not into intercellular junctions of vehicle controls, is consistent with PDOC-mediated increases in tight junctional permeability. In CF(-/-) mice, significant gene expression was not detectable after exposure to Ad5CBCFTR alone (1.4 x 10(9) PFU in 20 microl; AdCFTR), but PDOC pretreatment prior to AdCFTR instillation produced functional expression of CFTR (measured as deltaPD) 5 days after instillation. Because the development and testing of lung gene therapy will principally occur in children and adults with airway disease, AdLacZ gene transfer with and without PDOC pretreatment was examined in infected nasal airways. Gene expression was significantly reduced in infected as compared with uninfected airways. We conclude that the use of adjuvant surface-active and/or membrane-perturbing agents, synthetic or naturally derived, may provide a novel approach to enhancing the efficiency of adenoviral gene transfer.

Experimental studies of injection agents for peptic ulcer bleeding endoscopic control

AIM

To evaluate haemostatic effectiveness and tissue effects of injected therapy agents used for peptic ulcer bleeding endoscopic control.

METHODS

Bleeding gastric mucosa lesions were produced during operation in 11 heparinised dogs. Bleeding lesions were treated with injections of 1 ml of epinephrine (1:10000), ornipressin (0.2 IU/m]), 98% ethanol, 1% polidocanol, thrombin (1000 U/ml), or fibrin sealant. In another 18 dogs, gastric submucosal injections of tested agents were performed during operations. Dogs were killed 48 h after injections and tissue effects were studied.

RESULTS

The agents tested had similar effectiveness in achieving initial control of experimental bleeding (chi2 = 1.43). Vasoconstrictors caused no tissue injury or thrombosis in vessels after 48 h. Ethanol produced mucosa and submucosa necrosis and thrombosis in vessels. Polidocanol caused mucosa necrosis, submucosa oedema and thrombosis in vessels. Thrombin tissue effects were mucosa oedema, submucosa thrombosis in vessels. Fibrin sealant caused agent insertion between mucosa and submucosa, but no tissue injury or thrombosis in vessels.

CONCLUSIONS

Experiments did not show significant differences between investigated agents in achieving initial bleeding control. The investigated agents, according to the stomach tissue injury they caused in our experiment, would produce series: epinephrine = ornipressin < fibrin sealant < thrombin < polidocanol < ethanol, and according to their effect on vascular thrombosis: epinephrine = ornipressin = fibrin sealant < polidocanol < ethanol < thrombin.

Identification and characterisation of early reactions of asparagine-linked oligosaccharide assembly in Entamoeba histolytica

Sequential incubation of a mixed membrane fraction isolated from Entamoeba histolytica trophozoites with the nonionic detergents Brij 35 and Igepal CA-630 rendered a soluble fraction with the ability to transfer N-acetylglucosamine (GlcNAc) from UDP-GlcNAc to dolichol phosphate to form a lipid saccharide that was identified as a mixture of dolichol-P-P-GlcNAc and dolichol-P-P-(GlcNAc)2 as follows. (a) The reaction occurred only in the presence of exogenously added dolichol phosphate and was strongly inhibited by tunicamycin and amphomycin; (b) Over 90% of the aminosugar moiety of the lipid saccharide was released by mild acid hydrolysis and was identified as a mixture of GlcNAc and diacetylchitobiose [(GlcNAc)2]; (c) Time course experiments revealed that dolichol-P-P-(GlcNAc)2 accumulated at the expense of a parallel decrease in dolichol-P-P-GlcNAc revealing the tandem operation of UDPGlcNAc:dolichol-P GlcNAc-1-P transferase and UDPGlcNAc:dolichol-P GlcNAc transferase. Mg2+ and to a lower extent Mn2+ were required for catalytic activity and were optimal at 2.5 mM and 1.25 mM, respectively. Common phospholipids with different head groups failed to increase catalytic activity and phosphatidylglycerol was inhibitory. At low concentration, nucleotides such as ATP, GMP and GTP brought about stimulations of 24-54% but higher concentrations were inhibitory. Others were inhibitory at all concentrations the strongest being those containing a uridine base.

Oxidation of linoleyl alcohol by potato tuber lipoxygenase: possible mechanism and the role of carboxylic group in substrate binding

We have studied the aerobic oxidation of linoleyl alcohol (LAL) by potato tuber lipoxygenase in the presence of 0.02% (w/v) non-ionic detergent Lubrol PX (and its analog C12E10) and 0.1 mM sodium dodecyl sulfate to investigate the role of carboxylic group in substrate binding. While the enzyme displayed a comparable affinity toward LA and LAL, the rate of LAL oxidation was approximately one-fourth of that of linoleic acid. The pH-profile of the reaction suggests that the rate of LAL oxidation is controlled by two ionizable groups with pKa values of 5.3 and 7.5, with optimal pH being 6.4+/-0.1. Since LAL is not ionizable at this pH, we conclude that the rate of the reaction is controlled by two ionogenic groups of the enzyme. The primary dioxygenation product(s) of LAL had a maximal absorbance at 233+/-1 nm. The products have been isolated, catalytically hydrogenated with H2 over Pd on carbon, and analyzed by GC-MS. Two major equimolar products were found to be 9- and 13-hydroxystearyl alcohols, indicating that 9- and 13-hydroperoxylinoleyl alcohols are the primary dioxygenation products. Based on these results we propose that the carboxyl group of polyunsaturated fatty acid may not be involved in substrate binding of potato tuber lipoxygenase.

Cutaneous hemangioma of the penis successfully treated with sclerotherapy and ligation

A cutaneous hemangioma of the penis extending from the proximal portion of the glans to the prepuce of an 18-year-old man was successfully treated by sclerotherapy with polidocanol and interrupted ligation of the hemangioma.

Benefit of prophylactic endoscopic sclerotherapy of esophageal varices. A retrospective analysis

BACKGROUND

The therapeutic schedule in bleeding esophageal varices is today established: emergency endoscopy with sclerotherapy or ligation combined with somatostatin and decreasing portal pressure drug followed by repetitive sclerotherapy or ligation. But the approach to varices that do not bleed is not clear.

METHODS

The authors submit the results of a 6-year sclerotherapeutic program. Since January 1989 they have treated 421 patients with varices and have together performed 4,115 endoscopic sclerotherapeutic procedures. Among the 421 patients 95 were treated during acute bleeding and 254 were treated after first bleeding; in 72 patients prophylactic sclerotherapy (PSG) was performed.

RESULTS

The procedure was indicated, when grade III or IV varices or high-risk signs and/or hepatic venous pressure gradient (HVPG) > 15 in grade II varices were observed. Prophylactic therapy (not-treated group-NTG) refused next 31 selected patients. The mean follow-up time was 32 months in the PS group and 28 months in NTG (n.s.). Fifteen PSG patients died (21%), while the mortality among the NTG patients (13 = 42% patients) was significantly higher (P < 0.02).

CONCLUSIONS

We recommend prophylactic sclerotherapy with 1% polidocanol in patients with advanced varices in liver cirrhosis of varied etiology. We emphasize the need to perform these procedures in a department with adequate experience, where at least 100-200 sclerotherapies per year are performed.

Interaction of Triton X-100 with acyl pocket of butyrylcholinesterase: effect on esterase activity and inhibitor sensitivity of the enzyme

The effect of non-ionic detergents like Triton X-100, Lubrol PX, Brij 35 and Tween 80 on the esterase activity and inhibitor sensitivity of human serum butyrylcholinesterase (BuChE) were studied. The results showed that though BuChE is not a detergent dependent enzyme, the esterase activity and inhibitor sensitivity of it can be modulated by the presence of detergents. All the detergents caused a marginal activation of the esterase activity. The presence of Lubrol PX, Brij 35 or Tween 80 did not affect the 50% molar inhibition concentration (IC50) of the inhibitors tested. But in the presence of Triton X-100 the IC50 values were increased for neostigmine, eserine and tetraisopropylpyrophosphoramide (acylation site interacting inhibitors), whereas for inhibitors like ethopropazine, imipramine and procainamide (choline binding pocket specific inhibitors) the IC50 values were unaltered. In addition, in the presence of Triton X-100 the bimolecular reaction constant for phosphorylation reaction (ki) of BuChE for the acyl pocket specific tetraisopropylpyrophosphoramide was reduced. Triton X-100 partially protected BuChE against this tetraisopropylpyrophosphoramide inactivation. These results indicate that Triton X-100 by interacting with the acyl pocket hydrophobic region is able to activate the esterase activity of BuChE. Further it reduces the capacity of the enzyme to react with inhibitors that inactivate it by interacting with the serine residue of the acylation site.

[Fatal pulmonary embolism after endoscopic embolization of downhill esophageal varix]

HISTORY AND CLINICAL FINDINGS

A 79-year-old man was admitted with a history of recent haematemesis and tarry stools. 4 years before he had undergone a subtotal thyroidectomy for hyperthyroidism.

INVESTIGATIONS

He was anaemic (haemoglobin 7.2 g/dl, haematocrit 23%). At the transition between the upper and middle third of the oesophagus gastroscopy revealed a bleeding oesophageal varix.

TREATMENT AND COURSE

The bleeding varix was sclerosed with polidocanol. 3 erythrocyte concentrates were administered. Massive bleeding 2 days later was controlled with intravaricose injection of cyanoacrylate (Histoacryl). The patient died 6 weeks later from progressive cardiovascular failure. Autopsy revealed the cause of death as right heart failure with extensive foreign-body pulmonary emboli identified as thrombotic material containing polymerized cyanoacrylate found in the previously injected oesophageal varix. Also discovered was a retrosternal goitre which had compressed the brachiocephalic vein. Cause of the "washing-out" of the cyanoacrylate embolus from the varix into the systemic circulation was an oesophago-varicose collateral circulation in a cranio-caudal direction; this had been formed by the pressure of the retrosternal goitre on the brachiocephalic vein.

CONCLUSION

Cyanoacrylate injection into a varix above the lower third of the oesophagus should only be done under strict indication. A similar risk as that described in this case potentially exists in the treatment of acute bleeding from a portosystemic varicose circulation.

Influence of nonionic surfactants on the potentiometric response of ion-selective polymeric membrane electrodes designed for blood electrolyte measurements

The effect of the nonionic surfactants Brij 35 and Triton X-100 on the selectivity of neutral carrier-based ion-selective electrodes (ISEs) commonly used for measurements of electrolytes in whole blood is investigated. Studies are conducted with plasticized PVC membranes doped with several neutral ionophores commonly employed to prepare clinically useful potassium, calcium, and sodium ISEs. An observed increase in the electrodes' EMF values upon the addition of surfactant to the test solution suggests a change in the ion selectivity of the polymeric membranes in the presence of Brij 35 or Triton X-100. For membranes doped with K(+)-selective valinomycin, the effect of nonionic surfactants is relatively small. However, in the case of calcium-selective membranes prepared with ETH 1001 and ETH 129, nonionic surfactants, especially Triton X-100, decrease the selectivity for calcium over potassium cations by nearly 1 order of magnitude. Such behavior is even more dramatic for sodium-selective membranes, with the degree of surfactant-induced loss of ion selectivity dependent on the specific sodium ionophore employed, the lipophilic tetraphenylborate derivative content of the membrane, and the surfactant type. A detailed theoretical model is presented to explain the effect of nonionic surfactants on the EMF response function of cation-selective polymeric membrane electrodes. Experimental results are in good agreement with theoretical predictions based on known binding constants for ionophores and surfactants with given cations.

Migration behavior and separation of tetracycline antibiotics by micellar electrokinetic chromatography

The migration behavior and separation of six tetracyclines (TCs) were investigated by micellar electrokinetic chromatography (MEKC) in the pH range 5.0-9.0 using ammonium acetate buffer with the addition of sodium dodecyl sulfate (SDS). Mixed SDS-Brij 35, sodium cholate (SC) and tetradecyltrimethylammonium bromide (TTAB) were also used as surfactants. The influences of surfactant concentration and buffer pH on the separation of TCs were examined and the separations of TCs were optimized. Complete separation of six TCs was achieved within 8 min with 15 mM ammonium acetate buffer containing 20 mM SDS, with or without the addition of Brij 35 (0.135%, w/v), at pH 6.5 using a fused-silica capillary (42 cm x 75 microns I.D.) at 15 kV. In general, good linear correlations of the logarithm of migration factor (log k') versus the logarithm of octanol-water partition coefficient (log P(ow)) in these micellar systems, except for the TTAB-MEKC system, were obtained. The results indicate that the migration of TCs in MEKC is mainly based on hydrophobic interactions. However, hydrogen bonding interactions also play a significant role in influencing the chemical selectivity of TCs. In addition, the micelle-water partition coefficients (Pmw) of TCs, which are pH-dependent in the SDS-MEKC micellar system, are reported.

Different moieties of tautomycin involved in protein phosphatase inhibition and induction of apoptosis

The effects of tautomycin and its derivatives on protein phosphatases PP1 and PP2A and their apoptosis-inducing activity toward human leukemia Jurkat cells were examined, and the relationship between chemical structure and function was discussed. Among the compounds we examined, tautomycin was the most potent inhibitor and the most effective inducer of apoptosis. It inhibited PP1 and PP2A enzymatic activity concentration-dependently with IC50 values of 20 and 75 pM, respectively, in the presence of 0.01% Brij-35, and an LC50 value of 1 microM. Esterification of the anhydride moiety of tautomycin markedly increased the IC50 for the protein phosphatases. The C1'-C7' fragment of tautomycin had no inhibitory effect, but the fragment containing the C22-C26 moiety was inhibitory. These results suggest that the C22-C26 moiety is essential for inhibition of protein phosphatase activity and that the anhydride moiety enhances the inhibition. However, the esterification of the anhydride did not decrease, nor did the inclusion of the C22-C26 moiety increase the apoptosis-inducing activity. On the other hand, the C1-C18 moiety of tautomycin was essential for induction of apoptosis, and the conformation and the arrangement of functionalities of the C18-C26 carbon chain affected the apoptosis activity. However, modification of C1-C18, C1-C21, or C1-C26 compounds had little effect on phosphatase inhibitory activity. Our results strongly suggest that different moieties of tautomycin are involved in protein phosphatase inhibition and induction of apoptosis.

Immediate endoscopic injection therapy of bleeding oesophageal varices: a prospective comparative evaluation of injecting materials in Egyptian patients with portal hypertension

The present study was conducted to compare usual sclerosants: polidocanol 1%, ethanolamine oleate 5% and the tissue adhesive: cyanoacrylate in the control of oesophageal variceal bleeding in Egyptian patients with portal hypertension in a prospective comparative trial. Sixty patients with portal hypertension due to schistosomal hepatic fibrosis and/or posthepatitic liver cirrhosis who had presented with acute oesophageal variceal bleeding were enrolled. Patients received balloon tamponade prior to injection were excluded. Resuscitation had been done before or during emergency endoscopy. Emergency endoscopy was conducted within 2 hours from the onset of hematemesis. Patients were immediately randomized during emergency endoscopy to receive polidocanol 1%, ethanolamine oleate 5% or tissue adhesive. Variceal rebleeding was managed by reinjection. The three groups were comparable for age, sex, etiology of portal hypertension, Child-Pugh class and findings at emergency endoscopy. No active bleeding was observed at the end of all injection sessions. Rebleeding had been occurred within the first 24 hours in 2 (10%) patients in polidocanol group and 3 (15%) patients in ethanolamine group (P > 0.05). Reinjection did control rebleeding in 2 (10%) patients in ethanolamine group with a total success rate of 95%. Exsanguinating rebleeding occurred in 2 (10%) patients in polidocanol group and one (5%) patient in ethanolamine group (P > 0.05). Postinjection large ulcers were diagnosed either in polidocanol (15%) or ethanolamine (10%) groups (P > 0.05). Other complications were minor and showed no significant differences between the three groups. In coclusion, polidocanol, ethanolamine and cyanoacrylate are equally safe and effective. For immediate endoscopic injection therapy an experienced team must be available.

Endoscopic treatment of bronchopleural fistulas

BACKGROUND

Bronchial fistula is one of the most serious complications of pulmonary resection.

METHODS

We present an endoscopic treatment that consists of multiple submucosal injections of polidocanol-hydroxypoliethoxidodecane (Aethoxysklerol Kreussler) on the margins of the fistula using an endoscopic needle inserted through a flexible bronchoscope.

RESULTS

From 1984 to 1995, 35 consecutive nonselected patients with a postresectional bronchopleural fistula were treated. All 23 partial postpneumonectomy or postlobectomy bronchopleural fistulas, ranging from 2 to 10 mm in diameter, healed completely. This did not occur in the 12 total bronchial dehiscences. No complications occurred due to the injection of the drug.

CONCLUSIONS

In our opinion this treatment can be considered a valid therapeutic approach, as it is simple, safe, scarcely traumatic, and inexpensive, particularly considering that, in patients in stable condition, it can be performed as an outpatient treatment.

Endoscopic sclerotherapy in porcine esophagus changes luminal cross-sectional area and wall distensibility dose- and time-dependently

The dose- and time-dependent effects of endoscopic sclerotherapy on luminal cross-sectional area and wall distensibility were studied in pigs at 5 and 12 cm proximal to the gastroesophageal junction by means of impedance planimetry. Sixteen healthy animals underwent two sessions of endoscopic sclerotherapy two weeks apart with injections of either 5 or 10 ml of 1% Polidocanol in the distal 7 cm of the esophagus each time. The animals were investigated before sclerotherapy, two weeks after each session, and finally six weeks after the last session. Six healthy animals were studied as controls. Endoscopic sclerotherapy caused luminal narrowing in the sclerosed zone followed by normalization six weeks after the last treatment (P < 0.05 in both groups). Wall distensibility decreased in the sclerosed zone after treatment with 10 ml sclerosant (P < 0.05) followed by partial normalization, while no effect was found after 5 ml sclerosant (P > 0.2). Progressive dilations were observed in the proximal esophagus in both groups and were most pronounced in the 10 ml group (P < 0.05). Wall distensibility did not change proximal to the site of sclerotherapy in either group (P > 0.1).