Enteral nutrition prevents bacterial translocation but does not improve survival during acute pancreatitis

OBJECTIVE

To evaluate the effect of enteral nutrition (EN) in attenuating bacterial and/or endotoxin translocation, maintaining immune responsiveness, and improving outcome in early acute pancreatitis (AP) in Wistar male rats.

DESIGN

Acute pancreatitis was induced in rats receiving total parenteral nutrition (TPN) (AP/TPN group) (n=34) and EN (AP/EN group) (n=35) by pressure injection of 1% deoxycholate into the biliopancreatic duct (0.6 mg/kg of body weight). Rats in the sham/TPN and sham/EN groups (n=10 each) underwent laparotomy without induction of AP. Catheters for TPN and EN were placed into the external jugular vein and jejunum, respectively. Rats were infused with Ringer lactate solution for 48 hours followed by TPN in the AP/TPN and sham/TPN groups, and EN in the AP/EN and sham/EN groups until day 7. The fluid volume and energy (calories) intake were similar in all groups.

SETTING

Medical school research laboratory.

MAIN OUTCOME MEASURES

Survival, blood endotoxin level, villus height, 5-bromo-2'-deoxyuridine (BrdU) uptake in the jejunum and ileum, bacterial culture of mesenteric lymph nodes, and CD4/CD8 ratio of T cells in mesenteric lymph nodes, spleen, and peripheral blood.

RESULTS

There was no difference in survival and pancreatic healing between the AP/TPN and AP/EN groups. Colony-forming units of the mesenteric lymph nodes and the endotoxin level were significantly lower in the AP/EN group than in the AP/TPN group (P<.05). Villus height and BrdU intake was significantly higher in the AP/EN group than in the AP/TPN group (P<.05). The CD4/CD8 ratio of T cells in spleen and peripheral blood was higher in the AP/EN group than in the AP/TPN group (P<.05), whereas there was no difference in mesenteric lymph nodes.

CONCLUSIONS

Jejunal administration of EN is well tolerated in early AP, maintains immune responsiveness and gut integrity, and reduces bacterial and/or endotoxin translocation. However, compared with TPN, EN does not improve outcome. These results suggest that factors other than bacterial and/or endotoxin translocation may be responsible for mortality in this rat model of early AP. However, additional studies of both early bacterial and/or endotoxin translocation and late assessment of outcome are indicated.

Infantile myofibromatosis of the triceps detected by prenatal sonography

A routine prenatal sonographic examination at 36 weeks' menstrual age revealed a solid and slightly inhomogeneous soft-tissue tumor on a fetus's left upper arm. The mass in the left triceps brachii muscle measured 8 x 7 x 5 cm at birth. Because of progressive flexion contracture of the left elbow joint, at 2 months of age the infant underwent radical resection of the tumor, sparing some muscle fibers. Light microscopic and immunohistochemical studies revealed myofibromatosis. Neither tumor nor functional disorder of the arm was evident 3 years after surgery.

Subcapsular hemorrhage of the liver in a very-low-birth-weight neonate: survival after decompression laparotomy

Subcapsular hemorrhage of the liver in a very-low-birth-weight neonate was successfully treated by decompression laparotomy. This may be the second smallest survivor after surgery in the literature.

An unusual presentation of congenital infantile myofibromatosis arising from the interspinous ligament

The authors describe an extremely rare presentation of congenital infantile myofibromatosis. A full-term newborn boy presented with a thumb-sized subcutaneous mass on the mid-spinal line between the 2nd and 3rd lumbar spinous processes. A solid tumor arising from the interspinous ligament was resected. Microscopic and immunohistochemical studies revealed myofibromatosis.

Development of a compact six-circle goniometer

A compact versatile six-axis goniometer has been built which can be used with the scattering plane vertical or horizontal for anomalous X-ray diffraction and diffraction X-ray absorption fine structure using a tunable X-ray undulator at SPring-8. The diffractometer consists of a four-circle goniometer for the standard omega, 2theta, phi and chi motions and a two-circle goniometer on the 2theta arm for mounting the detector and analyser crystal. The goniometer is controlled via Ethernet, and standard data-acquisition software with a graphical user interface has been developed. A closed-cycle helium cryostat is mounted on the omega axis for temperature-dependent experiments from 330 K to 14 K. Preliminary experiments on a Bi(2)Sr(2)CaCu(2)O(8) single crystal demonstrate the performance. Superstructure peaks due to the one-dimensional spatial modulations in the b axis were recorded as a function of temperature above 20 K using an image plate.

Pump and probe X-ray absorption fine structure using high-brilliance photon sources

Pump and probe X-ray absorption fine structure (XAFS) is used as a local probe of excited atoms, which can provide direct information on lattice distortion, relaxation and atomic rearrangements associated with electronic excitations. In situ XAFS experiments during optical excitation are reported. Utilizing a grazing-incidence fluorescence excitation, which minimizes the mismatch between the probing depths of X-ray excitation and optical pumping, it is found that the dominant photoinduced defect state in amorphous selenium at low temperature is a pair of threefold neutral $C^0_3$ states: $2C^*_2 \rightarrow (C^0_3-C^0_3)$, where $C^*_2$ denotes the twofold excited lone-pair state. The results indicate that optical pumping of chalcogen atoms at low temperature leads to locally over-coordinated defect pairs similar to those in the liquid state. The origin of reversible photostructural changes, such as photodarkening or photoinduced fluidity, is attributed to the structural disorder caused by the formation and annihilation of dynamical interchain bonds during optical melting.

Congenital esophageal atresia with tracheoesophageal fistula occurring in both members of dizygotic twins

The authors present a pair of dizygotic twins with congenital esophageal atresia with tracheoesophageal fistula who underwent successful single-stage surgical repair. To our knowledge, this is the second set of dizygotic twins with this congenital anomaly in the literature.

[Clinical significance and problems in parenteral nutritional care]

The clinical indications for and types of intravenous nutritional support are reviewed from the standpoint of their advantages and disadvantages. Total parenteral nutrition (TPN, also known as intravenous hyperalimentation) improves and maintains not only nutritional status but immunocompetence in patients with restricted food intake, because almost all essential nutritional substrates can be administered in the parenteral root alone to meet energy requirements. In surgical fields, TPN reduces perioperative risk and complication rates and enhances postoperative recovery of patients with severe stress such as those under going thoracic esophagectomy or pancreatoduodenectomy. In addition to calory administration, another type of parenteral nutrition a the disease-specific formulation has been attempted to improve directly such pathophysiologic conditions as renal failure, hepatic failure, or sever acute pancreatitis. Despite the great benefits of TPN, it is associated with several complications related to the indwelling catheter or to inadequate substrates administered, Disuse atrophy of the intestinal mucosa in patients receiving TPN to decreases the host defense against bacterial infection. To avoid the abuse of TPN, the indications for it should be selected rigorously. Moderate calory administration of a maximum of 15-20 cal/kg/day via a peripherally inserted catheter has been reevaluated in patients on short-term fasts.

A new apparatus for polarized X-ray absorption fine structure using a grazing-incidence fluorescence excitation

A new apparatus is described for surface-sensitive X-ray absorption fine structure (XAFS) at the 27-pole wiggler beamline BL13B at the Photon Factory. The apparatus is designed for polarized XAFS experiments at low temperature. A closed-cycle helium cryostat is rotated around the omega axis of a vertically mounted high-precision goniometer. The apparatus can be used for XAFS and X-ray standing-wave experiments, sharing a 19-element pure-Ge detector array as a fluorescence detector. The available temperature range is 15-300 K. The performance is demonstrated by in-plane polarized Cu K-EXAFS for a YBa2Cu307 thin film (approximately 1000 A) epitaxically grown on an SrTiO3 single crystal. An in-situ study of amorphous selenium under optical excitation revealed that neutral defect pairs (C3(0)-C3(0)) are formed by photoexcitation of lone pairs. This indicates that grazing-incidence fluorescence excitation is advantageous for 'pump-and-probe' experiments which can minimize the mismatch in the probing depth between X-ray and optical excitation.

Intratumoral necrosis of lung carcinoma: a potential diagnostic pitfall in incremental dynamic computed tomography analysis of solitary pulmonary nodules?

The authors determined the pattern and enhancement range of necrotic lung carcinoma using incremental dynamic computed tomography (CT). Thirty-seven pathologically proven lung cancers (range, 8-57 mm in diameter) were evaluated using incremental dynamic CT. Scans were obtained before and 30 seconds, 2 minutes, and 5 minutes after the onset of contrast material injection. Computed tomography numbers in circular regions of interest (60% of tumor diameter) were calculated, and the difference in CT number between nonenhanced and the scan showing maximum attenuation was determined. In cavitary necrotic carcinomas, regions of interest were established excluding areas of cavitation. Nine (24%) of 37 lung carcinomas had intratumoral necrosis; four (11%) had noncavitary necrosis, and five (14%) had cavitary necrosis. Maximum attenuation of four noncavitary necrotic carcinomas (mean 31 +/- standard deviation 25 HU; range, -3-56 HU) was lower than cavitary necrotic carcinomas (42 +/- 8 HU; range, 35-51 HU; p = 0.36) and non-necrotic carcinomas (48 +/- 17 HU; range, 25-91 HU; p = 0.07). All carcinomas showed maximum attenuation > or = 25 HU except for one noncavitary necrotic carcinoma (maximum attenuation = -3 HU; 36 mm in diameter). Noncavitary necrosis was recognized as low attenuation on noncontrast scan in two of four cases and as an unenhanced area on enhanced scan in four of four cases. Although noncavitary necrotic lung carcinoma may rarely show maximum attenuation < or = 15 HU, necrotic material is recognized as unenhanced area on enhanced scan.

Giant purulent mesenteric cyst

Infected intra-abdominal cystic lymphangiomas are very rare. We report a case of a purulent mesenteric cyst, histologically a cystic lymphangioma, w which developed in a 1-year-old girl who presented with marked abdominal distension and high fever. Magnetic resonance imaging revealed that the huge cystic lesion occupied the entire peritoneal cavity. It originated from the mesocolon. It was removed completely, and contained sticky pus at the base where the right fallopian tube penetrated it, which indicated the focus of infection. This may be the first report of a purulent mesenteric cyst in which the route of infection was suspected.

Nitrite reductase from the magnetotactic bacterium Magnetospirillum magnetotacticum. A novel cytochrome cd1 with Fe(II):nitrite oxidoreductase activity

Cytochrome cd1 nitrite reductase was isolated from magnetite-containing cells of the magnetotactic bacterium Magnetospirillum (formerly Aquaspirillum) magnetotacticum, which was microaerobically cultivated under denitrifying conditions. The enzyme showed absorption maxima at 643 nm and 409 nm in the oxidized form, and at 663, 551, 522, and 418 nm in the reduced form. A distinctive split absorption band did not occur at about 550 nm. The pyridine ferrohemochrome spectra suggested the presence of heme c and heme d1 in the molecule. The enzyme was composed of two identical subunits each with a molecular mass of 54 kDa; each subunit contained one c-type and one d-type heme. The isoelectric point was 9.2. The redox potentials of heme c and heme d1 were estimated to be +191 mV and +180 mV, respectively. Although the enzyme showed cyanide-sensitive N,N,N',N'-tetramethyl-p-phenylenediamine-O2 oxidoreductase activity and N,N,N',N'-tetramethyl-p-phenylenediamine-nitrite oxidoreductase activity, the enzyme did not oxidize M. magnetotacticum ferrocytochrome c-550 and Pseudomonas aeruginosa ferrocytochrome c-551 in the presence of nitrite. Furthermore, sodium succinate did not cause the reduction of cytochrome cd1 in the crude cell-free extract prepared from the magnetite-containing bacterial cells. However, M. magnetotacticum cytochrome cd1 showed a novel Fe(II):nitrite oxidoreductase activity whereas P. aeruginosa cytochromes cd1 had no Fe(II):nitrite oxidoreductase activity. These results suggest that M. magnetotacticum cytochrome cd1 may function as a Fe(II)-oxidizing enzyme under microaerobic conditions using nitrite as electron acceptor.

[The long-term results of isolated aortic valve replacement with 19 mm prostheses]

Twenty-five patients underwent isolated aortic valve replacement with 19 mm valves (8 cases with St. Jude Medical prostheses, 7 cases with Carpentier Edwards Pericardial prostheses and 10 cases with Björk-Shiley prostheses). Postoperative echocardiography revealed data as follows. Peak pressure gradients (mmHg) were 40.4 +/- 14.4 (mean +/- S.D.) in the SJM group, 23.4 +/- 9.8 in the CEP group and 50.5 +/- 16.7 in the BS group. End-diastolic left ventricular dimension in the BS group and interventricular septum thickness in the CEP group was reduced significantly. All but one case were in NYHA functional class I or II, and clinical improvement was almost satisfactory in all groups. However, in the BS group, 4 cases showed peak pressure gradients more than 50 mmHg. We conclude that 19 mm aortic prostheses in this study can provide satisfactory results. However, as for mechanical valve, it may be undesirable to choose BS prosthesis.

Small peripheral lung carcinoma evaluated with incremental dynamic CT: radiologic-pathologic correlation

PURPOSE

To correlate incremental dynamic computed tomographic (CT) and pathologic findings in peripheral lung cancer.

MATERIALS AND METHODS

Lung lesions smaller than 3 cm in diameter were evaluated in 18 patients. CT values of the inner area of the nodule at plain CT and at 30 seconds, 2 minutes, and 5 minutes after administration of nonionic contrast material were calculated with incremental dynamic CT. Maximum attenuation was compared with pathologic type of lung carcinoma and with number of vessels and distribution of elastic fibers in the pathologic specimen.

RESULTS

Enhancement of all lesions was statistically significant (P < .0001). Maximum attenuation of lung carcinomas correlated positively with number of small vessels (diameter, 0.02-0.10 mm) (r = .77). Distribution of elastic fibers in the tumoral interstitium correlated with maximum attenuation (P = .04 between grades 1 and 3) and with number of small vessels (P = .01 between grades 1-3; P = .008 between grades 1 and 3).

CONCLUSION

Enhancement characteristics of lung carcinomas reflect the number of small tumoral vessels and the distribution of elastic fibers in the tumoral interstitium.

Surface-Sensitive XAFS in the Hard X-ray Region with Sub-Monolayer Sensitivity

Surface-sensitive X-ray absorption fine structure (XAFS) with sub-monolayer sensitivity based on grazing-incidence fluorescence detection is reported. The efficiency of fluorescence detection increased by more than two orders of magnitude by combining a multipole wiggler with a multi-element Si(Li) solid-state detector. The capability of the present technique for structural studies of surfaces and buried interfaces in the hard X-ray region was demonstrated by As K-edge XAFS studies of the InP(001) surface exposed to AsH(3) flow. The results indicated that ~0.1 monolayer As atoms are incorporated into the surface replacing the P atoms.

Takayasu's disease associated with ulcerative colitis

A 14-year-old female with ulcerative colitis developed right anterior cervical pain and high fever. Cervical contrast-enhanced computed tomography (CE-CT) showed a wall thickness of the right common carotid artery which suggested aortitis. Her pulmonary angiography demonstrated a narrowing of the pulmonary arteries and she was diagnosed as having Takayasu's disease associated with ulcerative colitis. HLA analysis showed Bw52 and DR2 haplotype, which is frequently found in patients with Takayasu's disease associated with ulcerative colitis.

[Two cases of asymptomatic primary biliary cirrhosis (PBC) accompanied with CREST syndrome]

Two cases of asymptomatic primary biliary cirrhosis (PBC) combining CREST syndrome. We have had encountered two primary biliary cirrhosis (PBC) patients overlapped with CREST syndrome. Case 1 was a 51-year-old female, who was suffering from Raynaud's phenomenon, esophageal dysmotility and sclerodactyly. Case 2 was a 67-year-old female, who was suffering from Raynaud's phenomenon, esophageal dysmotility, sclerodactyly and telangiectasia. They were free from itching and icterus. The histology of their biopsied liver specimen should stage I-II of Scheuer's classification. Their immunological findings showed anti-centromere antibody, (ACA) at a high titer (1 : 1280 dilution) and anti-mitochondrial antibody (AMA) at a low titer (1 : 40 dilution) positive in both. HLA DR types included DR2 and DRW8 in case 1, and did DR1 and DRW6 in case 2. Both patients are having good prognosis.