[Retroperitoneal abscess in a man with severe necrotizing pancreatitis]

HISTORY AND ADMISSION FINDINGS

A 65-year-old man was admitted to the emergency unit of another hospital with severe acute abdominal pain. Medial laparotomy revealed a tear in the lower pole of the capsule of the enlarged spleen. Results of some laboratory tests became available only after the procedure: Lipase and amylase levels were markedly elevated at 5097 U/l (normal range < 100 U/l) and 1776 U/l (normal range < 60 U/l), respectively. These findings suggested acute pancreatitis as cause of the acute abdominal pain. Conservative treatment was initiated, but because of progressive clinical deterioration with fever, dyspnea and tachyarrhythmia he was transferred to our hospital for further treatment.

INVESTIGATIONS, DIAGNOSIS AND TREATMENT

Chest X-ray revealed bilateral pleural effusion. Contrast-enhanced abdominal CT scan revealed an acute peripancreatic fluid collection and extensive pancreatic necrosis extending into the perirenal space, hilum of the spleen and transverse mesocolon. Despite the placement of multiple percutaneous pigtail catheters clinical improvement of the severe necrotizing pancreatitis was only temporary and repeated episodes of fever and septicaemia occured. Supported by a multidisciplinary consensus an endoscopic ultrasound (EUS)-guided transgastric drainage of the pancreatic abscess was performed with placement of two double-pigtail catheters and a nasocystic drain for irrigation. After this intervention the patient}s condition rapidly improved, inflammatory parameters normalized and the retroperitoneal abscess gradually resolved.

CONCLUSION

A multidisciplinary consensus and modern interventional approaches such as EUS-guided endoscopic therapy are mandatory to successfully approach severe necrotizing pancreatitis and its complications.

Cholangioscopic characterization of dominant bile duct stenoses in patients with primary sclerosing cholangitis

BACKGROUND AND STUDY AIMS

Primary sclerosing cholangitis (PSC) is associated with the development of cholangiocarcinoma in up to 10 % of patients. Cholangiography or endoscopic tissue sampling does not reliably distinguish between cholangiocarcinoma and a benign dominant bile duct stenosis. The aim of the present study was to assess the value of cholangioscopy for distinguishing between benign and malignant dominant stenoses in PSC patients.

PATIENTS AND METHODS

Fifty-three PSC patients with dominant bile duct stenoses were prospectively studied. Transpapillary cholangioscopy and endoscopic tissue sampling were carried out in addition to endoscopic retrograde cholangiography (ERC). The cholangiography and cholangioscopic findings were classified as malignant or benign by the investigators. A final diagnosis of malignant stenosis was based on positive histology and/or cytology, whereas a benign condition was assumed in cases of negative tissue sampling and uneventful extended clinical follow-up.

RESULTS

Twelve PSC patients (23 %) had dominant bile duct stenoses caused by cholangiocarcinoma, whereas 41 of the 53 patients (77 %) had benign dominant bile duct stenoses. Cholangioscopy was significantly superior to ERC for detecting malignancy in terms of its sensitivity (92 % vs. 66 %; P = 0.25), specificity (93 % vs. 51 %; P < 0.001), accuracy (93 % vs. 55 %; P < 0.001), positive predictive value (79 % vs. 29 %; P < 0.001), and negative predictive value (97 % vs. 84 %; P < 0.001). Transpapillary cholangioscopy is more sensitive and specific for characterizing malignant bile duct stenosis in comparison with endoscopic brush cytology.

CONCLUSIONS

Transpapillary cholangioscopy significantly increases the ability to distinguish between malignant and benign dominant bile duct stenoses in patients with PSC.

Einsatz von Echinacea-Extrakt bei tragenden und säugenden Sauen

Abstract. Title of the paper: Application of Echinacea-extract in pregnant and suckled sows In an experiment with thirteen sows (echinacea: n = 6; control: n = 7), the influence of Echinacea purpurea treatment of pregnant and suckled sows on immune system, health status, growth performance, and carcass quality of the offspring (echinacea: n = 69; control: n = 79) was investigated. Echinacea was given as liquid feed supplement during the whole pregnant and suckling period of sows in six intervalls (5 days of treatment, followed by 2 weeks of break, respectively). During the treatment time the daily dosage per sow in echinacea-group was 0.125 ml preparation of echinacea extract (incl. solution)/kg body weight. To measure the concentrations of immunoglobulin G (IgG), immunoglobulin A (IgA) and C-reactive protein (CRP) in serum, blood samples were taken by punction of V. cava cranialis (sows and piglets) at different times. The treatment of sows resulted in immunostimulatory effects both in sows and piglets with highest changes in peripartal period. In one day old piglets, the concentrations of IgG, IgA and CRP were significantly increased in echinacea-group (P = 0.0004, P < 0.0001, P = 0.05, respectively). Up to day 70 of age, the rate of therapeutical treatments of piglets from echinacea-treated sows was decreased in tendency (P = 0.08). The growth performance and carcass quality of offspring was not influenced by echinacea treatment of sows.

Polypyrimidine tract-binding protein (PTB) inhibits Hepatitis C virus internal ribosome entry site (HCV IRES)-mediated translation, but does not affect HCV replication

Polypyrimidine tract-binding protein (PTB) has previously been shown to affect Hepatitis C virus (HCV) IRES-mediated translation. In the present study we investigated the functional role of PTB for HCV translation, replication and chronic HCV infection. Bicistronic HCV IRES reporter plasmids and two different subgenomic replicons (bicistronic: pHCVrep1bBB7 (s1179I); monocistronic: pFK1-389/hyg-ubi/NS3-3'/5.1) were used to analyze the effects of PTB. Following transfection of plasmids expressing PTB RNA in sense or antisense orientation, translational activity and HCV RNA were analyzed by luciferase assay, quantitative real-time RT-PCR and northern blot analysis. Additionally, in liver tissue (n = 53) intrahepatic PTB RNA levels were determined by quantitative real-time RT-PCR. Significant inhibition of HCV IRES activity up to 42.6% was observed upon PTB sense RNA expression for HCV IRES reporter plasmids, while translational activity was enhanced up to 63.8% for PTB antisense RNA expression. In the HCV replicons PTB did not affect replication and no correlation was found between intrahepatic PTB mRNA levels and serum HCV RNA or histological changes in liver tissue of HCV infected patients. Although PTB inhibits HCV IRES-mediated translation from bicistronic reporter constructs, data obtained from two subgenomic HCV replicons and liver tissue do not indicate a significant role of PTB for HCV replication and chronic HCV infection.

[Results of video-assisted thoracoscopic surgery for pneumothorax]

INTRODUCTION

Video-assisted thoracoscopic surgery has been used in the treatment of pneumothorax since 1990. There is still no general agreement regarding the procedure to obliterate the pleural space or regarding the indication for wedge resection if no blebs or bullae can be found.

PATIENTS AND METHODS

Clinical records referring to 100 video- assisted thoracoscopic operations for pneumothorax, performed in Berlin-Buch between 1998 and 2001, were retrospectively evaluated with regard to the rate of recurrences and postoperative complications in connection with the operative procedure. There were 70 male and 28 female patients aged from 16 to 78 years. The mean age was 34 years. The statistical significance was evaluated by the McNemar-test.

RESULTS

74 patients showed a regular postoperative course. Severe postoperative complications occurred in 9 patients: re-operation via thoracotomy n=5 (postoperative bleeding n=2, recurrence n=2, persistent air-leak n =1); re-thoracoscopy n=3 (postoperative bleeding n=2, recurrence n=1), pleural empyema n=2. The complication rate was significantly higher (p < 0.001) in patients with underlying pulmonary diseases (secondary spontaneous pneumothorax) or thoracic surgery in their history. Depending on the intraoperative situation, the cause of pneumothorax and the patient's general condition the pleural space was obliterated by the following procedures: apical parietal pleurectomy (n=85), electro-pleurodesis alone (n= 7), electro-pleurodesis and pleural abrasion (n=3), talcum poudrage (n=2). The rate of major complications was lower (p < 0.001) when pleurectomy was performed 8.2 % (7/85) compared to those operations performed without pleurectomy 13.3 % (2/15). The rate of re-operations for recurrences/persistent air leaks or empyemas following persistent air leaks was significantly lower (p < 0.001) when wedge resection 3.75 % (3/80) had been performed compared with operations without wedge resection 10 % (2/20).

DISCUSSION

Apical parietal pleurectomy and wedge resection of blebs or bullae are effective methods to prevent recurrences. Considering the specific complications of parietal pleurectomy alternative methods to obliterate the pleural space should be used depending on the intraoperative situation. Among other factors underlying pulmonary diseases or thoracic surgery in the patient's history strongly influence the postoperative outcome independently of the operative procedure.

Luminal salmonella endotoxin affects epithelial and mast cell function in the proximal colon of pigs

BACKGROUND

Salmonellosis and systemic endotoxaemia affect intestinal function. However, little is known about the functional importance of luminal Salmonella (S.) endotoxin during intestinal infection.

METHODS

Pigs were either given or not given lipopolysaccharide (LPS, 30 mg day(-1)) of S. Typhimurium DT-104 orally for 14 days. Blood samples were taken weekly. After slaughter (day 14), epithelia of the proximal colon were investigated in Ussing chambers. Bacterial translocations to lung, liver, spleen and several lymph nodes were determined by culture.

RESULTS

Endotoxin feeding increased plasma C-reactive protein (CRP) and histamine levels without evoking clinical signs. Postmortem, proximal colonic epithelia of LPS-treated animals showed both a decreased histamine release after mast cell stimulation with A23187 and a smaller increase in short-circuit current after A23187 application. Addition of the nitric oxide donor, sodium nitroprusside (SNP), also elicited lower increases in short-circuit current in the proximal colon of endotoxin-treated pigs. Endotoxin pre-feeding decreased colonic ion conductance, although mannitol and histamine fluxes were high in some epithelia of this group. Luminal Salmonella endotoxin increased bacterial translocation to proximal jejunal lymph nodes. LPS applied to colonic epithelia in vitro had no electrophysiological effects.

CONCLUSIONS

Luminal endotoxin elicits an acute phase response and affects intestinal electrolyte transport and mast cell function. Furthermore, LPS induces epithelial spots of increased mannitol permeability that could be identical to spots of enhanced bacterial translocation.

Prediction algorithm for amino acid types with their secondary structure in proteins (PLATON) using chemical shifts

The algorithm PLATON is able to assign sets of chemical shifts derived from a single residue to amino acid types with its secondary structure (amino acid species). A subsequent ranking procedure using optionally two different penalty functions yields predictions for possible amino acid species for the given set of chemical shifts. This was demonstrated in the case of the alpha-spectrin SH3 domain and applied to 9 further protein data sets taken from the BioMagRes database. A database consisting of reference chemical shift patterns (reference CSPs) was generated from assigned chemical shifts of proteins with known 3D-structure. This reference CSP database is used in our approach for extracting distributions of amino acid types with their most likely secondary structure elements (namely alpha-helix, beta-sheet, and coil) for single amino acids by comparison with query CSPs. Results obtained for the 10 investigated proteins indicates that the percentage of correct amino acid species in the first three positions in the ranking list, ranges from 71.4% to 93.2% for the more favorable penalty function. Where only the top result of the ranking list for these 10 proteins is considered, 36.5% to 83.1% of the amino acid species are correctly predicted. The main advantage of our approach, over other methods that rely on average chemical shift values is the ability to increase database content by incorporating newly derived CSPs, and therefore to improve PLATON's performance over time.