Valve system does not reduce the catheter-related bloodstream infection

BACKGROUND

The Groshong catheter (GC) is considered to have a lower risk of central venous catheter-related bloodstream infection (CVC-RBSI) than conventional catheters because of its valve system (closed-end) for preventing blood reflux. However, few studies have compared the GC with conventional (open-end) catheters in terms of catheter-related complications.

PURPOSE

To compare the incidence of catheter-related complications including CVC-RBSI between the GC and the Argyle catheter (AC).

METHODS

The GC and the AC were inserted in the same way from the internal jugular vein. Catheter-related complications were evaluated from the database retrospectively.

RESULTS

Two hundred seventy GCs were inserted in 123 patients, and 251 ACs were inserted in 135 patients. There were no significant differences in patient background factors between GC and AC use, except for the following two parameters. Use of GC was associated with a longer catheter insertion length and a younger patient age. Univariate analysis revealed that neither type of catheter reduced the incidence of CVC-RBSI. Kaplan-Meier analysis and log rank test revealed no significant difference between the GC and the AC in the period from insertion to development of complications.

CONCLUSIONS

The GC has no superiority over the conventional AC for preventing CVC-RBSI.

Serum factors that suppress cytotoxic effect of methotrexate

AIM

To study the phenomenon that human erythroid leukemia K-562 cells are more sensitive to cytotoxic effect of antimetabolites when cultured in a serum-free medium than in a conventional medium containing fetal calf serum (FCS).

METHODS

Cytotoxic effects of methotrexate, azaserine and 5-fluorouracil were estimated by accessing the lactate dehydrogenase (LDH) activity of viable tumor cells. Proteins of FCS were separated using two-dimensional electrophoresis followed by mass spectrometry analysis.

RESULTS

Addition of 10% FCS attenuated anti-tumor activity of methotrexate and azaserine against K-562 cells compared with serum-free medium. Such an activity of FCS was different for each serum lot. Comparison of the proteins in active serum lot with those in not active one using two-dimensional electrophoresis showed that in the active serum there were proteins 150 kDa, which were absent in the not active serum lot. Mass spectrometry indicated that all those proteins had the amino acid sequence of albumin. Sera of one healthy volunteer and two patients with thyroid cancer also attenuated the activity of the agent.

CONCLUSION

Several lots of FCS and human serum demonstrated the ability to attenuate the cytotoxic effect of methotrexate in vitro, possibly due to the formation of albumin dimers/MTX complexes.

In vivo anti-tumor activities of gelatin

AIM

As reported previously, porcine skin gelatin exerted direct anti-tumor effect in vitro and induced anti-tumor peritoneal macrophages in vitro. The present study investigated whether or not the gelatin exerted anti-tumor effect in vivo.

METHODS

In vitro anti-tumor activities of peritoneal macrophages and the gelatin were evaluated with tritium thymidine uptake by target tumor cells. In vivo anti-tumor activity was evaluated with the survival of tumor-bearing animals and the size of the tumor.

RESULTS

Intraperitoneal daily administration of 12.5 mg of the gelatin prolonged the survival of mice which had been intraperitoneally inoculated with MH134 (hepatic cell carcinoma cell line) or Colon 26 (colon carcinoma cell line) tumor cells, and there were no tumors in case of MH134 cells inoculation. Intraperitoneal daily administration of 12.5 mg of the gelatin did not affect growth of subcutaneous MH134 tumor. The gelatin administered subcutaneously did not affect the survival of mice with intraperitoneal MH134 tumor. On the other hand, bovine skin gelatin administered subcutaneously achieved statistically significant prolongation of the survival. The contact of MH134 cells with porcine skin gelatin for 5 min was required for the gelatin to exert its anti-tumor activity in vitro. Porcine skin gelatin of 12.5 mg injected intraperitoneally was detected as protein in the peritoneal cavity 5 min after the injection. Peritoneal macrophages elicited by intraperitoneal injection with porcine skin gelatin suppressed tritium thymidine uptake by MH134 cells more strongly than those elicited by thioglycollate injection.

CONCLUSION

Porcine skin gelatin administered intraperitoneally prolonged the survival of tumor-bearing mice via activation of peritoneal macrophages and involvement of direct anti-tumor activity of porcine skin gelatin. Key Words: porcine skin, gelatin, dissemination.

Retrorectal epidermoid cyst with unusually elevated serum SCC level, initially diagnosed as an ovarian tumor

Retrorectal epidermoid cyst is one of the developmental cysts which arise from remnants of embryonic tissues. We report a rare case of retrorectal epidermoid cyst, initially diagnosed as an ovarian tumor. Serum SCC value as tumor marker was elevated to the high level. Laparoscopy revealed ovaries, uterus and other pelvic organs were all normal. This tumor existed in the retroperitoneal cavity and compressed the rectum. Later, complete tumor resection was performed by laparotomy. Histological study revealed the epithelium of this tumor consisted of only squamous cells without atypia, and the diagnosis of this tumor was retrorectal epidermoid cyst. Retrorectal epidermoid cyst is very rare, and difficult to diagnose before surgery. However, if we have-knowledge of developmental cysts, and by careful digital examination and image diagnosis, a differential diagnosis can be made.

Influence of inflammation-based prognostic score on mortality of patients undergoing chemotherapy for far advanced or recurrent unresectable colorectal cancer

11084

Background: Recent studies have revealed that the Glasgow prognostic score (GPS), an inflammation-based prognostic score that includes only C-reactive protein (CRP) and albumin, is a useful tool for predicting postoperative outcome in cancer patients. However, few studies have investigated the GPS in patients undergoing chemotherapy for far advanced or recurrent unresectable colorectal cancer (AR-UCRC). Objective: To demonstrate the influence of the GPS for prognostication of patients undergoing chemotherapy for AR-UCRC. Methods: The GPS was calculated as follows: patients with both an elevated level of CRP (>1.0 mg/dl) and hypoalbuminemia (<3.5 g/dl) were allocated a score of 2, and patients showing one or none of these blood chemistry abnormalities were allocated a score of 1 or 0, respectively. Results: One hundred twelve patients who had undergone chemotherapy for AR-UCRC with regimens such as such as FOLFIRI (5-fluorouracil [5-FU]/l-leucovorin [LV]/irinotecan hydrochloride [CPT-11]) or FOLFOX (5-FU/LV/oxialiplatin [L-OHP]) were evaluated retrospectively. Kaplan-Meier analysis and log rank test revealed that GPS2 predicted a higher risk of mortality than GPS0 or 1 (P <0.0001). Univariate analyses revealed that the neutrophil ratio (P = 0.0411), CA19–9 (P = 0.0473), CRP (P = 0.0477), albumin (P = 0.0043) and GPS (0,1/2) (P < 0.0001) were associated with mortality. Multivariate analyses using these five factors revealed that only GPS (0,1/2) (odds ratio, 6.071; 95% C.I., 1.625–22.68; P = 0.0073) was an independent risk factor of mortality. Conclusions: GPS is considered the most important and independent predictor of mortality in patients undergoing chemotherapy for AR-UCRC.

No significant financial relationships to disclose.

Transnasal fine gastrointestinal fiberscope-guided long tube insertion for patients with small bowel obstruction

BACKGROUND

The use of a transnasal fine gastrointestinal fiberscope (TNF-GIF) has been rapidly disseminating in Japan. However, there has been no trial of long tube insertion (LTI) using the TNF-GIF for patients with small bowel obstruction (SBO).

PURPOSE

To examine whether TNF-GIF-guided LTI is superior to conventional LTI for patients with clinically diagnosed SBO.

METHODS

The time required for LTI was determined prospectively in each group of patients who underwent the conventional method (group 1, n = 10) and the TNF-GIF-guided method (group 2, n = 10) between March 2007 and November 2007. Insertion time was compared between groups 1 and 2.

RESULTS

Insertion time in group 2 was significantly shorter than that in group 1 (group 1, 22 +/- 16 min versus group 2, 9.2 +/- 5.4 min; P = 0.03).

CONCLUSIONS

Novel TNF-GIF-guided LTI is useful and superior to the conventional method.

Comparison between treatment of kitchen-sink wastewater and a mixture of kitchen-sink and washing-machine wastewaters

In this paper, a submerged membrane bioreactor was used to treat 'higher-load' grey water: (a) kitchen-sink wastewater only, and (b) a mixture of kitchen-sink wastewater and washing-machine wastewater. For each type of wastewater, three systems operated at different hydraulic retention times (HRTs) were investigated. In the mixture of kitchen-sink wastewater and washing-machine wastewater, the reactor with a short HRT of four hours was stopped due to foaming. It has been observed that for both types of wastewater, an HRT of eight hours or longer can be used for the treatment. However, it has been observed that a higher COD in the permeate of the mixture can be obtained compared with that of the kitchen-sink wastewater only. This indicated that washing-machine wastewater has some component that is not easily biodegradable. The total linear akylbenzene sulfonate (LAS) removal was > 99% even at a concentration of 10-23 mg 1(-1).

Anti-tumor activity of murine peritoneal macrophages induced by porcine skin gelatin

AIM

To study the induction of anti-tumor activity of murine peritoneal macrophages in vitro by porcine skin gelatin.

METHODS

Anti-tumor activity of the macrophages was evaluated with tritium thymidine uptake by target tumor cells. ELISA was used to measure amounts of cytokines secreted in culture medium.

RESULTS

The ability of the gelatin to induce anti-tumor activity of the macrophages was stronger than that of lipopolysaccharide of E. coli. Combination of the lipopolysaccharide and interferon-gamma synergistically stimulated the macrophages but that of the gelatin and interferon-gamma additionally did. The culture supernatant of the macrophages incubated with the gelatin also showed higher anti-tumor activity than that with the lipopolysaccharide though the lipopolysaccharide was more excellent than the gelatin in stimulating secretion of anti-tumor cytokines (IL-1, IL-6, TNF-alpha, IFN-gamma) by the macrophages. Anti-TNF-alpha antibody partially suppressed the anti-tumor activity of the culture supernatant of the macrophages incubated with the lipopolysaccharide but not with the gelatin. The gelatin induced anti-tumor activity of the macrophages of C3H/HeJ as well as C3H/HeN mice whereas the lipopolysaccharide did only in C3H/HeN mice. The macrophages stimulated in vitro by the gelatin exerted anti-tumor activity in vivo. Moreover, the gelatin stimulated peritoneal exudates cells in vivo when subcutaneously administered with them.

CONCLUSIONS

Porcine skin gelatin induces anti-tumor activity of macrophages in mice and its magnitude is greater than that of lipopolysaccharide of E. coli. Its mechanism is different from that of the lipopolysaccharide but not fully clarified.

Clinical assessment of oral malodor intensity expressed as absolute value using an electronic nose

OBJECTIVES

In our previous study, scores determined via a multiple linear regression method (EN-MLR) involving an electronic nose provided objective halitosis-related measurements; however, this model afforded only relative expression exclusively. The objective of this investigation was to assess clinically oral malodor intensity expressed as an absolute value using an electronic nose.

SUBJECTS AND METHODS

Sixty-six subjects were evaluated based on results of an actual organoleptic test (OLT), measurements of volatile sulfur compound (VSC) concentrations, a score representing malodor intensity (EN-MI) as the absolute value and EN-MLR measured with an electronic nose system. Oral health parameters were also examined.

RESULTS

The OLT score served as a benchmark. The area under the receiver-operating characteristic (ROC) plots of EN-MI score (0.975) was significantly larger than that of log VSC (0.896) (P = 0.036); however, the area did not differ significantly from that of EN-MLR score (0.932). Percentage of teeth with pocket depth greater than or equal to 4 mm, tongue coating score and plaque control record displayed meaningful association with EN-MI score in multiple logistic regression analyses.

CONCLUSION

Oral malodor intensity expressed as an absolute value employing an electronic nose may be a suitable method for clinical evaluation of oral malodor.

POSSUM is an optimal system for predicting mortality due to colorectal perforation

BACKGROUND/AIMS

The purpose of this study was to determine the most useful predictive scoring system for the postoperative mortality of patients with colorectal perforation using the Acute Physiological and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and Physiological and Operative Severity Score for the enUmeration of Mortality (POSSUM).

METHODOLOGY

First, the 3 scoring systems were applied to all patients, and the efficacy of these systems was compared between survivors and non-survivors. Second, using receiver operating characteristic (ROC) curve analysis, optimal cut-off values were determined for each system and patients were divided into another two groups (high score group and low score group). Then statistical analyses were performed, respectively.

RESULTS

All scoring systems gave significantly lower scores for survivors than for non-survivors. POSSUM was the most sensitive system for predicting operative mortality (POSSUM: sensitivity 87.5%). Kaplan-Meier analysis and log rank test revealed that there were significant differences between the high score group and the low score group, except for APACHE II. Multivariate logistic regression analysis revealed that only POSSUM was an independent predictor (odds ratio, 0.858; 95% C.I.; 0.736-1,000; p = 0.0498).

CONCLUSIONS

POSSUM is an optimal predictor of mortality following emergency surgery for colorectal perforation.

Usefulness of Groshong catheters for central venous access via the external jugular vein

This study was designed to evaluate the usefulness of central venous access via the external jugular vein (EJV) employing Groshong catheters, and to compare the complications with those of conventional internal jugular venous catheterization. Central venous access was achieved by insertion of a single-lumen 4.0 Fr Groshong catheter via the EJV or internal jugular vein (IJV) with a single puncture. Complications associated with insertion and central venous catheter-related bloodstream infection (CVC-RBSI) were evaluated from the database. Two hundred and twenty-five patients received 400 catheters for a total period of 5377 catheter-days. Ninety-six patients underwent 201 internal jugular venous catheter (IJV-C) procedures for 2381 catheter-days, and 129 patients underwent 199 external jugular venous catheter (EJV-C) procedures for 2996 catheter-days. Use of EJV-C was associated with a longer catheter insertion length (p < .01) and period (p < .01), a larger number of operations (p < .01), and more frequent use of total parenteral nutrition (TPN) (p < .01) and less frequent use of chemotherapy (p < .01) than for IJV-C. However, there were no significant differences (NS) in complications associated with insertion and CVC-RBSI between IJV-C and EJV-C. There were no significant differences such complications as malposition, oozing or hematoma formation of insertion site, arterial bleeding, nerve damage, pneumothorax, and phlebitis between IJV-C and EJV-C. Moreover, EJV-C was not associated with morbidities such as pneumothorax, arterial bleeding, and nerve damage. Thus the study concluded that EJV-C using Groshong catheters has no severe complications and has the same rates of CVC-RBSI as conventional IJV-C for central venous access.

Hepatectomy for metastatic liver tumor in patients with liver dysfunction

BACKGROUND/AIMS

In the present study, we evaluated the safety and long-term outcome of liver resection for metastatic liver tumor in patients with liver dysfunction.

METHODOLOGY

Sixty-one patients, who underwent liver resection for metastatic liver tumor, were retrospectively divided into two groups, based on the retention rate of indocyanine green at 15 minutes (ICGR15). Group 1: ICGR15 < 10% (n = 34), Group 2: ICG R15 > 10% (n = 27). Patient background, perioperative data (operation time, blood loss, duration of Pringle's maneuver, volume of resected liver), duration of postoperative hospital stay, and three-year survival rate were compared between the two groups. All data were expressed as median values.

RESULTS

There were no differences in patient backgrounds between the two groups. No significant differences were observed betweens Group 1 and 2 for operation time (383.5 vs. 345.0 min), blood loss (390 vs. 296mL), duration of Pringle's maneuver (55 vs. 42 min), volume of resected liver (402.5 vs. 110.0 mL), or duration of postoperative hospital stay (26 vs. 26 days). The three-year survival rates in Groups 1 and 2 were 72.9% and 87.8%, respectively (p = 0.937).

CONCLUSIONS

Liver resection for metastatic liver tumor in patients with liver dysfunction can be performed safely, and the long-term outcome is comparable to that in patients with normal function.