[Effect of complementary treatment of Chinese drugs on myocardial perfusion patients with acute myocardial infarction after coronary intervention: a systematic review]

OBJECTIVE

To systematically review the safety and efficacy of routine Western medicine (WM) plus Chinese drugs for no-flow or slow flow after coronary revascularization.

METHODS

CNKI, VIP, CBM, Wanfang Data, PubMed, The Cochrane Library, EMBase, and other relevant databases were electronically searched. Literatures were also manually retrieved from related journals. Randomized control trials of treating no-flow or slow flow patients after coronary revascularization by routine WM treatment plus Chinese drugs were retrieved. The quality of retrieved literature was assessed by methods from Cochrane Handbook. Valid data were extracted and analyzed by meta-analysis using RevMan5. 1.0 Software. Results Totally 5 trials including 526 patients with poor general quality were included.

RESULTS

of meta-analyses showed that compared with the routine WM treatment group, additional use of Chinese drugs could improve thrombolysis in myocardial infarction (TIMI) [RR =0. 16, 95% Cl (0.07, 0.34), P < 0.01]; reduce elevated ST segment significantly [RR = 0.59, 95% CI (0.44, 0.79), P = 0. 00031]; in- crease regional myocardial blood flow (P < 0.01) and myocardial perfusion scores (P = 0.0109, P = 0.0115); and improve left ventricular ejection fraction (LVEF) under dobutamine stress state (P = 0.041). Only one trial covered a 6-month follow-up study. There was no statistical difference in the mortality, recurrent myocardial infarction, or revascularization between the two groups. There was no statistical difference in adverse event or safety indicators between the two groups.

CONCLUSIONS

Compared with the WM treatment, complementary Chinese drugs could reduce occurrence of no-flow or slow flow after coronary revascularization, and further improve clinical efficacy. But larger and higher quality clinical trials are necessary for further evidence.

Carbon utilization profiles of Fusarium virguliforme isolates

Fusarium virguliforme is the cause of sudden death syndrome in soybean. Physiological variability among isolates of the fungus is unknown. One way to measure physiologic variability is to analyze growth on different carbon sources. The carbon source utilization profiles of 18 F. virguliforme isolates were examined using the Biolog FF 96-well microplate, which contains 95 different carbon sources. The utilization of dextrin,D-mannitol, maltotriose,D-lactic acid methyl ester, N-acetyl-D-galactosamine, salicin, D-trehalose, and L-alanine differed significantly among isolates (P = 0.05). Carbon sources were grouped into 3 clusters based on their ability to promote growth of F. virguliforme, after calculating Euclidean distances among them. About 12% of the carbon sources promoted a high amount of mycelial growth, 39% promoted a medium amount of growth, and 49% promoted a low amount of mycelial growth; the latter was not significantly different from the water blank control. A hierarchical tree diagram was produced for the 18 isolates based on their carbon source utilization profiles using Ward's hierarchical analysis method. Two main clusters of isolates were formed. One cluster represented greater average mycelial growth on all of the carbon sources than the other cluster. In this study, variability in carbon source utilization among F. virguliforme isolates was evident, but the results were not associated with geographic origin of the isolates, year collected, or published data on aggressiveness. Additional research is needed to determine if these carbon utilization profiles are associated with other biological characteristics, like spore germination, propagule formation, and saprophytic competitiveness.

Novel de novo BRCA1 mutation in a woman with early onset breast cancer

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Background: Germline mutations in BRCA1/2 account for a significant portion of hereditary breast/ovarian cancer. Mutation carriers usually have a family history of breast/ovarian cancer or early onset disease. Rarely, germline mutations are found only in the probands but not in any family members. Such de novo mutations have been reported in diseases such as hemophilia A, thalassaemia and familial adenomatous polyposis. De novo mutations in the BRCA1 or BRCA2 genes are rare and the few reported have been in BRCA2. Here, we describe de novo as well as novel mutation of the BRCA1 gene in a breast cancer patient. Methods: Blood DNA samples from a 30 year old Chinese woman with breast cancer and no family history of cancer was tested for a BRCA1/2 mutation by full gene sequencing and Multiple Ligation-dependent Probe Amplification (MLPA). Family members were analyzed for the same mutation. Paternity was determined by a set of highly polymorphic short tandem repeat (STR) markers. Results: Full gene sequencing found no deleterious mutation. MLPA revealed a large deletion of exons 1 to 12 of BRCA1 in the proband. MLPA performed on 5 family members: proband's mother and father (who were 1st degree relative- cousins), stepmother (mother's biological sister), 2 sisters (1, same parents; 1, same father and stepmother) found no similar deletion. By using a set of highly polymorphic STR markers, the proband's father and mother were confirmed to be her biological parents. Conclusions: We report a novel de novo BRCA1 deletion mutation encompassing exons 1 - 12 in a Chinese breast cancer patient of early onset with no family history. Identification of this large deletion confirms the importance of pursuing rearrangement testing if full gene sequencing fails to detect a point mutation or short insertion deletion. The mutation found in this study is de novo. This may simply be a random mutation event which occurred in the parents' germ cells during their lifetime which passed onto one of their offspring or maybe a result of gene inversion or splicing deficiency. The relations of such mutations with consanguineous marriage cannot be ruled out. Mutation screening is important in early onset breast cancer patients even if there is no family history.

No significant financial relationships to disclose.

Clinical and pathological characteristics of Chinese patients with BRCA related breast cancer

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Background: Breast cancers due to underlying germline BRCA1 and BRCA2 mutations are associated with particular pathological features that may differ from sporadic breast cancers. We report clinical and pathologic characteristics of breast cancer in a clinical cohort of high risk Chinese women with BRCA mutations and those without mutations. Methods: 202 high risk women based on their age and family history were recruited from March 2007 to November 2008. Medical information was prospectively collected from the patients and medical records. BRCA1 and BRCA2 mutations were detected using full gene sequencing and multiplex ligation-dependent probe amplification (MLPA). Results: Of the 202 female probands tested, 25 (12.3 %) were BRCA mutation carriers of which 11 (44%) were BRCA1 and 14 (56%) were BRCA2 mutations. Breast cancer risk factors, other than family history, did not differ between carriers and non-carriers. Mutation carriers were more likely to have a familial history of breast cancer (p=0.07) and personal and family history of ovarian cancer (p=0.005; p=0.007). Other cancers found in carriers families included pancreatic, gastric, colon, lung, liver, and nasopharyngeal. 23% of women diagnosed with DCIS had BRCA mutations compared with 11.4% of those with invasive cancers. BRCA related tumors were more likely to be ER, PR and Her-2 negative (Triple negative, TN) (p= 0.006). Overall 9.6% of non-BRCA cancers were TN whereas 25.9% of BRCA cancers were TN. Prevalence of TN in BRCA1 carriers is 71% compared with 13.4% in BRCA2 carriers. BRCA1 mutation related cancers were significantly more likely to be ER negative than BRCA2 and this is only significant in those who are under 40 years of age (p=0.070). Conclusions: We have a high BRCA2 mutation rate in our cohort. BRCA related breast cancer is associated with families with increasing number of first degree relatives with breast and/or ovarian cancers and were higher for DCIS cancers. Prevalence of TN breast cancers was high compared to Caucasian cohorts. BRCA mutations were associated with pathologically, poor prognostic features (TN and high grade) especially in younger women.

No significant financial relationships to disclose.

Alcohol Substitution and Dehydrogenation of Selenium Compounds: A Convenient Preparation of Trisubstituted Furans from allyl-substituted 1,3-dicarbonyls

Trisubstituted furans have been synthesised efficiently by an alcohol substitution and dehydrogenation reaction of selenocyclic enol ethers which were prepared by organoselenium-induced regioselective electrophilic intramolecular cyclisation of allyl-substituted 1,3-dicarbonyls.

Juvenile ossifying fibroma of the maxilla

Juvenile ossifying fibroma is a rare fibro-osseous neoplasm in young children. This lesion is locally aggressive and spreads quickly, and because it has a very high recurrence rate complete excision is essential. Reported here is a case of a massive juvenile ossifying fibroma of the maxilla in an 11-year-old male child. A titanium mesh was used to reconstruct the facial contour after a left total maxillectomy, achieving a satisfactory facial appearance.

Solid-Phase Synthesis of 1,2-Diheterocyclic-Substituted (E)-Olefins from a Supported Selenium Resin

A library of 1,2,3-triazoles, isoxazoles, 1,2,4-oxadiazoles, and isoxazoline-containing 1,2-di-heterocyclic-substituted compounds with three points of diversity linked by an E double bond were prepared. Key steps include a 1,3-dipolar cycloaddition and Porco's two-step, one-pot condensation and alpha-alkylation reaction of selenium resins.

Studies on the synthesis of 5-(p-aminobenzylidene)-rhodanine and its properties

A new analytical reagent 5-(p-aminobenzylidene)-rhodanine (ABR) was synthesized. The acidic dissociation constant of ABR has been determined. The properties, the acid-base behavior of ABR and the reactions of ABR with metallic ions have been studied. The color reactions of the reagent with Pd(II), Au(III), Ag(I), Ru(III), Hg(II) and Cu(II) are studied in detail. The composition of Pd(II)-ABR, Au(III)-ABR and Ag(I)-ABR complexes were discussed.

Suppression of tumor necrosis factor-mediated apoptosis by nuclear factor kappaB-independent bone morphogenetic protein/Smad signaling

The activation of nuclear factor kappaB (NF-kappa B) plays a pivotal role in the regulation of tumor necrosis factor (TNF)-mediated apoptosis. However, little is known about the regulation of TNF-mediated apoptosis by other signaling pathways or growth factors. Here, unexpectedly, we found that bone morphogenetic protein (BMP)-2 and BMP-4 inhibited TNF-mediated apoptosis by inhibition of caspase-8 activation in C2C12 cells, a pluripotent mesenchymal cell line that has the potential to differentiate into osteoblasts depending on BMP stimulation. Utilizing both a trans-dominant IkappaBalpha inhibitor of NF-kappaB expressed in C2C12 cells and IkappaB kinase beta-deficient embryonic mouse fibroblast, we show that BMP-mediated survival was independent of NF-kappaB activation. Rather, the antiapoptotic activity of BMPs functioned through the Smad signaling pathway. Thus, these findings provide the first report of a BMP/Smad signaling pathway that can inhibit TNF-mediated apoptosis, independent of the prosurvival activity of NF-kappaB. Our results suggest that BMPs not only stimulate osteoblast differentiation but can also promote cell survival during the induction of bone formation, offering new insight into the biological functions of BMPs.

Neurological sequelae and long-term behavioural assessment of rats with transient middle cerebral artery occlusion

Animal models of stroke, notably transient middle cerebral artery occlusion (MCAo), are used to assess the efficacy of pharmacological and transplant treatments. Long-term studies (>1 month) of the functional effects of treatments in animal models are required to predict treatments likely to improve dysfunctions associated with stroke damage. These pre-clinical studies require (1) optimum post-operative care to ensure long-term survival, (2) methods for assignment of rats to groups with equivalent impairments to reduce variability and enhance detection of treatment effects, and (3) behavioural tests that detect long-term stable deficits. For long-term functional assessment, a battery of behavioural tests sensitive to a range of deficits observed after MCAo was developed. The bilateral asymmetry test evaluated the time course of sensory neglect. Deficits of motor integration were examined in the footfault test, and motor bias was assessed by pharmacological stimulation of rotation. The water maze was used to detect long-term deficits in spatial information processing. Long-term differences between control and MCAo animals in this battery of tests indicate that the protocol provides an efficient assessment suitable for evaluating treatment outcomes in pre-clinical studies of stroke, and that the post-operative care procedure and method of assignment to groups were effective.

Naphthyl ketones: a new class of Janus kinase 3 inhibitors

Potent inhibition of Janus kinase 3 was found for a series of naphthyl(beta-aminoethyl)ketones (e.g. 7, pIC50 = 7.1+/-0.3). Further studies indicated that these compounds fragment in less than 1 h by retro-Michael reaction in the Jak3 in vitro ELISA assay procedure. The breakdown product of 7, 2-naphthylvinyl ketone (22, pIC50 = 6.8+/-0.3) showed very similar inhibitory activity to 7. Compounds 7 (in neutral buffer) and 22 will be useful pharmacological tools for the investigation of the Janus tyrosine kinase Jak3.

Taurine inhibition of metal-stimulated catecholamine oxidation

Taurine is an abundant amino acid found in mammalian tissues and it has been suggested to have cytoprotective functions. The aim of the present study was to determine if taurine had the potential to reduce oxidative stress associated with metal-stimulated catecholamine oxidation. Taurine and structural analogs of taurine were tested for their ability to inhibit metal-stimulated quinone formation from dopamine or L-dopa. Oxidative damage to proteins and lipids were also assessed in vitro and the effects of taurine were determined. Taurine (20 mM) was found to decrease significantly ferric iron (50-500 microM)- and manganese (10 microM)-stimulated L-dopa or dopamine oxidation. Taurine had no effect on zinc-induced dopamine oxidation and slightly potentiated copper- and NaIO(4)-stimulated quinone formation. Ferric iron-stimulated lipid peroxidation was not affected by taurine (1-20 mM). Protein carbonyl formation induced by ferric iron (500 microM) and L-dopa (500 microM) was significantly reduced by 10 mM taurine. The cytotoxicity of L-dopa (250 microM) and ferric chloride (75 microM) to LLC-PK(1) cells was attenuated by 10 mM taurine or hypotaurine. Homotaurine alone stimulated L-dopa oxidation and potentiated the cytotoxic effects of ferric iron. Homotaurine was found to be cytotoxic when combined with L-dopa or L-dopa/iron. In contrast, hypotaurine inhibited quinone formation and protected LLC-PK(1) cells. These studies suggest that taurine may exhibit cytoprotective effects against the oxidation products of catecholamines by acting as a scavenger for free radicals and cytotoxic quinones.

Pharmacological profile of ZD1611, a novel, orally active endothelin ETA receptor antagonist

The endothelins (ETs), potent vasoconstrictor peptides, have been implicated in the pathogenesis of various cardiovascular disorders. In the present study, we describe the novel, potent, orally active, selective ET(A) receptor antagonist ZD1611 [3-(4-[3-(3-methoxy-5-methylpyrazin-2-ylsulfamoyl)-2-pyridyl ]phenyl)- 2,2-dimethylpropanoic acid]. ZD1611 competitively inhibited (125)I-labeled ET-1 binding at human cloned ET(A) and ET(B) receptors with pIC(50) values of 8.6 +/- 0.1 and 5.6 +/- 0.1, respectively, showing 1000-fold selectivity for the ET(A) receptor. ZD1611 caused a parallel rightward shift of the concentration response curve to ET-1 in the rat isolated aorta yielding a concentration of antagonist that caused a 2-fold rightward shift in the ET-1-response curve (pA(2)) of 7.5 +/- 0.3. When administered i. v. to anesthetized rats and dogs, ZD1611 caused dose-related rightward shifts of partial dose-response curves to the precursor of ET-1, big ET-1. Threshold doses for significant antagonist activity were determined as 0.1 mg/kg and 0.3 mg/kg in the rat and dog, respectively. Importantly, ZD1611 was able to reverse an established big ET-1-induced pressor response in pithed rats in the presence of continuous big ET-1 infusion. Failure of ZD1611 to inhibit the BQ3020 (ET(B)-selective)-induced depressor response in pithed rats indicated a lack of activity at the endothelial ET(B) receptor. ZD1611 was orally active in the rat at 0.3 mg/kg and had a duration of action of more than 7 h, and, in the dog, a dose of 0.6 mg/kg p.o. was active for at least 6 h. In conclusion, these data demonstrate that ZD1611 is a potent and orally active, selective ET(A) receptor antagonist with a long duration of action which may be of therapeutic use.

Anticonvulsant actions of LY 367385 ((+)-2-methyl-4-carboxyphenylglycine) and AIDA ((RS)-1-aminoindan-1,5-dicarboxylic acid)

We have studied the effects in three rodent models of generalised convulsive or absence epilepsy of two antagonists of group I metabotropic glutamate receptors that are selective for the mGlu1 receptor. LY 367385 ((+)-2-methyl-4-carboxyphenylglycine) and AIDA ((RS)-1-aminoindan-1,5-dicarboxylic acid) have been administered intracerebroventricularly (i.c.v.) to DBA/2 mice and lethargic mice (lh/lh), and focally into the inferior colliculus of genetically epilepsy prone rats (GEPR). In DBA/2 mice both compounds produce a rapid, transient suppression of sound-induced clonic seizures (LY 367385: ED50 = 12 nmol, i.c.v., 5 min; AIDA: ED50 = 79 nmol, i.c.v., 15 min). In lethargic mice both compounds significantly reduce the incidence of spontaneous spike and wave discharges on the electroencephalogram, from <30 to >150 min after the administration of AIDA, 500 nmol, i.c.v., and from 30 to >150 min after the administration of LY 367385, 250 nmol, i.c.v. LY 367385, 50 nmol, suppresses spontaneous spike and wave discharges from 30 to 60 min. In genetically epilepsy prone rats both compounds reduce sound-induced clonic seizures. LY 367385, 160 nmol bilaterally, fully suppresses clonic seizures after 2-4 h. AIDA is fully effective 30 min after 100 nmol bilaterally. It is concluded that antagonists of mGlu1 receptors are potential anticonvulsant agents and that activation of mGlu1 receptors probably contributes to a variety of epileptic syndromes.

An improved technique for laparoscopic highly selective vagotomy using harmonic shears

BACKGROUND

Results from classic highly selective vagotomy (HSV) are technique dependent because an incomplete operation will result in early recurrence of duodenal ulcer. Few reports describe laparoscopic completion of the procedure. All techniques use clips for division of neurovascular branches, making the laparoscopic approach tedious and thus the results, uncertain.

METHODS

Ten patients with intractable duodenal ulcer and negative Helicobacter pylori status underwent an extended HSV. All procedures were performed laparoscopically using a new surgical tool, the harmonic shears.

RESULTS

All procedures were completed laparoscopically and took approximately 1 h. There were no deaths and no postoperative complications. Patients were discharged the next day. Follow-up endoscopy at 2 months showed healing of duodenal ulcer in all cases, and postoperative acid secretion studies demonstrated a decrease in basal acid output (BAO) by 74% (8.2 meq/h to 2.16 meq/h) and maximal acid output (MAO) by pentagastrin stimulation by 79.2% (40 to 8.32).

CONCLUSIONS

Harmonic shears expedite laparoscopic HSV. The operation can be taught safely, yields good results in early follow-up, and represents an acceptable option in patients with intractable duodenal ulcers who are H. pylori negative.

New wiggler beamlines at BSRF

A new multipole wiggler has been installed in the ring of the Beijing Electron Positron Collider (BEPC), and two new beamlines were extracted from it for experiments, including LIGA, microprobe fluorescence analysis, high-pressure diffraction and soft X-ray research. The beam profile and photon intensity were measured and compared with the calculated values. The main parameters and characteristics of the two beamlines are illustrated. Some experimental results are presented.

Prolonged anticonvulsant action of glutamate metabotropic receptor agonists in inferior colliculus of genetically epilepsy-prone rats

The anticonvulsant activity of (S)-4-carboxy-3-hydroxyphenylglycine ((S)-4C3HPG) (an antagonist of Group I and an agonist of Group II metabotropic glutamate (mGlu) receptors), of (1S,3S)-1-aminocyclopentane-1,3-dicarboxylic acid ((1S,3S)-ACPD) (an agonist of Group II mGlu receptors), and of L-serine-O-phosphate (an agonist of Group III mGlu receptors) was studied against sound-induced seizures in genetically epilepsy-prone (GEP) rats following bilateral microinjection into the inferior colliculus. All 3 drugs produce dose-dependent suppression of all phases of sound-induced seizures (wild running, clonic and tonic). (S)-4C3HPG produces an immediate and short-lasting (< 2 h) protection against sound-induced seizures with an ED50 value of 4.3 (3.2-5.7) nmol, at 5 min. The preferential agonists of Group II and Group III mGlu receptors produce an immediate, transient (< 10 min) proconvulsant effect followed by a prolonged (> 1 day) anticonvulsant effect against sound-induced seizures. The anticonvulsant ED50 value for (1S,3S)-ACPD is 9 (5-18) nmol at 2 h, and for L-serine-O-phosphate is 36 (6.5-199) nmol at 2 days. It is concluded that mGlu receptor activation potently modifies seizure threshold.

Laparoscopic lumbar sympathectomy

BACKGROUND

Lumbar sympathectomy retains a role in the treatment of patients with causalgia, Symptomatic vasospasm, and nonreconstructable arterial occlusive disease. Open surgical sympathectomy, with its attendant morbidities, remains the standard. Chemical sympathectomy has been introduced as a less invasive means of achieving sympatholysis. However, this has been associated with incomplete and transient denervation.

METHODS

We present a series of five lumbar sympathectomies performed laparoscopically.

RESULTS

All patients sustained symptomatic relief and no postoperative complications were noted. Postoperative skin thermometry and resistance measurements confirmed adequacy of sympatholysis.

CONCLUSION

We conclude that lumbar sympathectomy can be performed laparoscopically. Our preferred technique is now the extraperitoneal approach. Such an approach combines the durability and reliability of standard open sympathectomy with the minimal invasiveness of laparoscopic surgery.

Anticonvulsant effects of 7-nitroindazole in rodents with reflex epilepsy may result from L-arginine accumulation or a reduction in nitric oxide or L-citrulline formation

1. To investigate the role of nitric oxide in epilepsy we have studied the effects of agents which affect nitric oxide synthesis in sound-induced seizures in DBA/2 mice and in genetically epilepsy-prone (GEP) rats. 2. The neuronal selective nitric oxide synthase inhibitor, 7-nitroindazole (7-NI) is anticonvulsant in these models with ED50 values against clonic seizures in mg kg-1 i.p. (times following injection) of: 74 (+0.25 h), 120 (+1 h) in DAB/2 mice, and 56 (+0.25 h), 42 (+0.5 h), 36 (+1 h), 28 (+2 h), 38 (+4 h), 93 (+8 h) in GEP rats. 3. Therapeutic indices (locomotor deficit ED50/anticonvulsant ED50) for 7-NI are low, ranging from 0.6 to 1.1 at +0.25 h to +1 h after administration in GEP rats, but are more favourable at later times (1.6 at +2 h and 2.9 at +4 h). 4. The substrate for nitric oxide synthase, L-arginine (500-5000 mg kg-1, i.p. or 100-300 micrograms, i.c.v.) but not D-arginine (300 micrograms i.c.v.) is anticonvulsant in DBA/2 mice. L-Arginine (500-5000 mg kg-1, i.p. or 1800-6000 micrograms, i.c.v.) is a more potent anticonvulsant than D-arginine (1500-2500 mg kg-1, i.p. or 6000 micrograms, i.c.v.) in GEP rats. 5. In DBA/2 mice, L-arginine (30 micrograms i.c.v.) reverses the anticonvulsant effect of 7-NI (50 mg kg-1, i.p.). 6. In GEP rats, low dose L-arginine (25-50 mg kg-1, i.p.) but not D-arginine (50 mg kg-1, i.p.) reverses the anticonvulsant effect of low dose 7-NI (25 mg kg-1, i.p.). A higher dose of L-arginine (500 mg kg-1, i.p.) or 7-NI (50 mg kg-1, i.p.) produces summation of anticonvulsant effect. 7. The product for nitric oxide synthase, L-citrulline (250-831 micrograms i.c.v.), is convulsant in DBA/2 mice. 8. The anticonvulsant effect of the neuronal selective nitric oxide synthase inhibitor, 7-nitroindazole, may therefore be mediated by L-arginine accumulation, as well as by a reduction in nitric oxide and L-citrulline formation in rodent models of reflex epilepsy.

Intraabdominal abscesses following laparoscopic and open appendectomies

BACKGROUND

The purpose of this review was to evaluate the incidence of postoperative intraabdominal abscess formation following laparoscopic and open appendectomies.

METHODS

The current study retrospectively examines appendectomies performed during the period from January 1993 to July 1994. Excluded were cases which were started laparoscopically but converted to open procedures. There were 1,287 cases identified; 597 were perforated (46%), 114 were gangrenous (9%), and 576 were acute (45%). These diagnoses represent intraoperative diagnoses.

RESULTS

Of the 576 appendectomies for acute appendicitis, 64 (11%) were performed laparoscopically. There were four intraabdominal abscesses (0.7%), all occurring after open procedures. Of the 114 appendectomies for gangrenous appendicitis, 16 (14%) were done laparoscopically. There were two postoperative abscesses (1.8%), one following an open and one following a laparoscopic procedure. There was no significant difference in abscess rate between laparoscopic and open appendectomies for either acute or gangrenous appendicitis. Of the 597 appendectomies for perforated appendicitis, 28 (5%) were done laparoscopically. There were 19 postoperative abscesses in the whole group, accounting for a 3.2% abscess rate. Sixteen abscesses occurred after open appendectomies and three occurred after laparoscopic appendectomies (2.9% vs 11%, P = 0.054). The preoperative diagnosis was incorrectly identified as acute appendicitis in 95 cases subsequently found to have perforated appendicitis; there was only 1 postoperative abscess in this group. There was no difference in postoperative stay in the open vs laparoscopic group (6.3 days vs 6.1 days).

CONCLUSIONS

We found no significant difference in the rate of postoperative intraabdominal abscess formation between laparoscopic and open appendectomies in cases of acute or gangrenous appendicitis. However, laparoscopic appendectomy for perforated appendicitis was associated with an important trend toward a higher rate of postoperative intraabdominal abscess formation than open appendectomy. This observation calls for closer prospective scrutiny of laparoscopic appendectomy in the setting of perforated appendicitis.

Laparoscopic evaluation of penetrating thoracoabdominal traumatic injuries

BACKGROUND

General surgeons' recent familiarity with advanced laparoscopic techniques have rendered laparoscopy feasible safely in the trauma setting. Traditionally high rates of nontherapeutic laparotomies also contribute to this increased interest. This study was undertaken to determine the predictive value and accuracy of diagnostic laparoscopy (DL) in evaluation of penetrating thoracoabdominal trauma.

METHODS

Entry criteria included thoracoabdominal gunshot (GSW) or stab wounds (SW) in otherwise hemodynamically stable patients. A high index of suspicion for either hemoperitoneum, peritonitis, or diaphragmatic injury was required for inclusion. All patients underwent DL in the operating room followed by standard laparotomy. The findings of the two evaluations were compared.

RESULTS

Twenty-four patients were included in the study. Twenty males and 4 females with an average age of 34 years made up the group. Violation of the peritoneal cavity was present in 21 cases and absent in 3. No intraabdominal injuries were found during laparotomy in the latter three cases without peritoneal violation. The specificity and positive predictive value were 100% for lesions of the diaphragm, liver, spleen, pancreas, kidney, and hollow viscus. The sensitivity was highest for liver and spleen injuries (88%), followed by diaphragmatic injuries (83%), pancreas and kidney injuries (50%), and lowest for injuries of hollow viscus (25%). The negative predictive value was 95, 99, 91, and 57%, respectively, for these organs.

CONCLUSIONS

DL could have avoided unnecessary laparotomy in 38% of cases in this study. There were no complications related to laparoscopy. The greatest value of DL in penetrating thoracoabdominal injuries is in the evaluation of peritoneal violation, diaphragmatic, and upper abdominal solid-organ injuries. It is not ideal for predicting hollow viscus injuries.

Bowel obstruction in cancer patients

OBJECTIVE

To examine the efficacy of various interventions on bowel obstruction occurring in patients with a history of cancer.

DESIGN

Retrospective case series.

SETTING

A university comprehensive cancer center.

PATIENTS

Sixty-one patients presenting with 81 episodes of intestinal obstruction.

RESULTS

Sixty-nine episodes of obstruction affected the small bowel, including 24 complete obstructions. There were 12 episodes of large-bowel obstruction, eight of which were complete. Five patients (8.2%) had concurrent small- and large-bowel obstruction. In 59 cases, the cause was established: 36 (61%) were due to metastatic tumor and 23 (39%) were due to benign conditions. Of the 49 episodes of partial bowel obstruction, 42 (86%) initially were treated medically. Nineteen (45%) of these 42 cases of obstruction resolved after 8.7 +/- 11.1 days (mean +/- SD) of conservative management. Twenty-two patients with partial obstruction were treated surgically, with relief of obstruction in 15 cases (68%). Of the 32 episodes of complete obstruction, 26 (81%) were initially managed conservatively; in only one case (3.8%) did obstruction resolve. Surgery successfully relieved the obstruction in 16 (76%) of 21 patients. Twenty-six patients received parenteral nutrition at home as the major treatment for obstruction; 22 (85%) experienced relief of nausea and vomiting. Patients with malignant obstructions survived 0 to 24 months (median, 4.7 months); the median survival for those treated surgically was 5.0 months.

CONCLUSIONS

In patients with a history of cancer, partial obstruction (but not complete obstruction) frequently resolves with medical management. Surgical intervention relieves most cases of partial or complete obstruction regardless of benign or malignant cause, but survival often is limited in the latter group. The entire intestinal tract should be evaluated in all patients, since 8.2% of patients in this series had concurrent small- and large-bowel obstructions. Home parenteral nutrition often provides symptomatic palliation in patients not amenable to surgical relief.

The application of the human beta-globin gene locus control region and murine erythroleukemia cell system to the expression and pharmacological characterization of human endothelin receptor subtypes

The cDNAs encoding both A and B subtypes of the human endothelin receptor have been inserted into mammalian cell expression vectors that utilize the human globin gene, locus control region. These constructs have been introduced into murine erythroleukemia cells and inducible high level expression of the receptors has been achieved (approximately 1.5-pM/mg membrane protein and approximately 13,500 binding sites/cell for both receptor subtypes). Cell lines expressing these receptors were obtained on a rapid time scale (3-4 weeks), facilitated by the need for the analysis of only small numbers of cell clones/receptor (approximately 6). Competitive binding assays with endothelin-1 gave IC50s of 130 +/- 30 pM for endothelin-A receptor and 160 +/- 30 pM for endothelin-B receptor. Similar studies with the different isoforms of endothelin, sarafatoxin-S6b and -S6c, BQ123 and BQ3020, all gave the expected selectivity profiles. The IC50s for all compounds were in close agreement with those reported for native receptors. Thus, this expression system, which has several advantages over other described expression systems, is capable of rapidly providing large quantities of receptor for detailed pharmacological analyses or drug screening. In addition, the expressed receptors display the expected pharmacological profiles in the absence of any complicating, competing interactions from other subtypes or binding sites.

Timing of laparoscopic surgery in gallstone pancreatitis

OBJECTIVE

To study the effect of the timing of laparoscopic cholecystectomy following acute gallstone pancreatitis.

SETTING

University-based county teaching hospital.

DESIGN

Retrospective case series.

PATIENTS

One hundred forty-two patients with gallstone pancreatitis treated by laparoscopic cholecystectomy between April 1991 and September 1993. There were 16 men and 126 women, with a mean age of 39.5 years. The mean serum amylase level at admission was 1616 U/L. All patients were operated on more than 48 hours after admission, after clinical and biochemical resolution of pancreatitis. Preoperative endoscopic retrograde cholangiopancreatography was performed in 25 patients (more than 48 hours after admission), with common bile duct stones being identified and removed in 10.

RESULTS

Twenty patients had three or more Ranson's criteria. Of these, nine had laparoscopic cholecystectomy attempted within the first week of admission. Six (67%) of these patients required conversion to open procedures (two for common bile duct exploration, one for repair of a common hepatic duct injury, and three for anatomic distortion due to inflammation). The mean postoperative stay of the nine patients was 5.4 days. The other 11 patients with three or more Ranson's criteria were operated on after 1 week, and only two required conversion to open cholecystectomy (18%). The mean postoperative stay in these 11 patients was 2.3 days. The difference in conversion rate approached but did not reach statistical significance (P = .08). The postoperative stay, however, was significantly shorter in the group of patients who underwent late operations (P = .03). There were 122 patients with fewer than three Ranson's criteria. In this group, there was no difference in length of postoperative stay between patients operated on earlier and those operated on later (2.4 vs 3.9 days; P = .49; n = 74 and n = 48, respectively). Of these 122 procedures, eight were converted to open procedures (6.6%). There was no significant difference in conversion rates in these patients regardless of whether they were operated on earlier or later.

CONCLUSIONS

Based on these data, we believe, first, that laparoscopic cholecystectomy is safe in patients recovering from gallstone pancreatitis (mortality rate, 0%; bile duct injury, 0.7%). Furthermore, early operation can safely be recommended in patients with mild pancreatitis. However, in patients with three or more Ranson's criteria, operation during the first week following admission is associated with an increase in operative complications, an increased rate of conversion, and longer postoperative stays.

The Schizosaccharomyces pombe MBF complex requires heterodimerization for entry into S phase

In Schizosaccharomyces pombe, MBF is a DNA-binding complex suspected to activate the transcription of genes necessary for entry into S phase. The MBF complex contains both p85cdc10 and p72res1/sct1. To obtain a better understanding of how the MBF complex regulates gene expression at the G1/S transition, we have performed a genetic analysis of p72res1. We determined that p72res1 can bind specifically to the cdc22 promoter, when analyzed by gel mobility shift assay, and that the N-terminal 157 amino acids of p72res1 are sufficient for this specific binding. When overexpressed in vivo, a fragment of p72res1 containing this DNA-binding domain could rescue a strain carrying a temperature-sensitive cdc10 allele at the restrictive temperature as well as a strain with a cdc10 null allele. We also determined that the C-terminal region of p72res1 is necessary and sufficient for binding to p85cdc10. Overexpression of the cdc10-binding domain of p72res1 leads to a G1 arrest with a cdc phenotype and a decrease on MBF activity. Overexpression of full-length p72res1 also leads to a growth arrest that can be rescued by overexpression of p85cdc10. These results imply that the MBF activity in vivo is dependent on the interaction of p85cdc10 with p72res1.

Intravenous pyelography in penetrating trauma

Intravenous pyelograms (IVPs) are routinely used in the workup of suspected urologic injuries. The indications for obtaining IVPs have not been well characterized. This study examined 67 patients with penetrating trauma who received formal IVPs with nephrotomography in the radiology department. Of 35 stab wounds, 19 patients presented without hematuria and accounted for only one positive IVP. No intervention was undertaken in this patient. There were 14 stab wound patients with microscopic hematuria, with three positive IVPs. No intervention was necessary in any of these patients. The two remaining stab wound patients both had gross hematuria and renal injuries requiring intervention. However, only one of the two had a positive IVP, showing a blurred kidney margin. One patient had a pseudoaneurysm of a branch of the renal artery, and the other had an arteriovenous fistula. Of 32 patients with gunshot wounds, 15 presented without hematuria. Of the 15, one had a positive IVP but did not have a renal injury on exploration. None of the other 13 patients in this group undergoing exploration had renal injuries. Of the 11 patients with microscopic hematuria, three had hematomas and one had gross extravasation on IVP. Of the six patients with gross hematuria, three had positive IVPs, showing a hematoma, a renal fracture, and indistinct renal outline, respectively. In this limited study, omitting IVPs on the patients with negative urinalyses would not have missed any significant injuries. We suggest that more study is needed in this area because our present standard may lead to unnecessary expense and delay.