Postoperative selective bowel decontamination prevents gram-negative bacterial translocation in small-bowel graft recipients

Gram-negative septic episodes are a potential risk of small-bowel transplantation; bacterial translocation through the graft is considered the mechanism. As a measure to prevent this complication, we evaluated postoperative selective bowel decontamination (SBD) in the rat model of orthotopic small-bowel transplantation [Lewis (LEW) and Brown-Norway (BN) rats as donors and recipients]. For 4 days after transplantation we gave FK 506, 2 mg/kg, which prevents rejection and results in indefinite recipient survival. For SBD, 24 mg/kg/day polymyxin E and 20 mg/kg/day tobramycin were administered via orogastric gavage to allograft recipients, both with and without FK 506 therapy. On Day 9, all rats were sacrificed, the peritoneal cavity was swabbed, and mesenteric lymph nodes (MLN), spleen, liver, and ileum were harvested for microbial qualitative and quantitative analysis. Animals with positive peritoneal swab cultures were excluded. SBD resulted in a significant reduction of the quantitative gram-negative bacterial flora in the ileum and cecum and of bacterial translocation to the MLN [0% versus 50% (no FK 506 therapy) and 8% versus 50% (FK 506 treated)]. In the allograft groups not treated with FK 506, SBD failed to significantly prolong survival, suggesting that acute rejection is not hastened by infection (bacterial translocation). We conclude that SBD in small-bowel-graft recipients prevents bacterial translocation by reducing intestinal gram-negative bacterial flora; this may reduce local and systemic infections by gut-derived organisms.

The anatomy of the basal ganglia and Parkinson's disease: a review

The present understanding of the anatomy of the basal ganglia has been updated. Recent work has produced a primate model of Parkinson's disease for study of its pathogenesis and treatment. In the last two decades, administration of dopamine agonist has been the mainstay of treatment of Parkinson's disease in the humans. However, recent use of dopamine-rich tissue such as adrenal gland or human foetal cells is opening up a new frontier for the treatment of more severe Parkinsonism. Nevertheless, there is still much to be learned at the basic neuroscience level before such procedure could be used widely in clinical practice.

Preservation of cytoplasm in the human lymphocyte micronucleus assay

A major limitation in the quantitative accuracy of the human lymphocyte micronucleus (MN) assay is preservation of the cytoplasm during the cell harvesting. In this short communication, an improved method for cytoplasm preservation in a cytokinesis-blocked, whole-blood microculture (0.3 ml) technique is described. We believe that the timing of the hypotonic treatment, speed of centrifugation, handling of the cell suspension and proper Giemsa staining are important variables in the human peripheral lymphocyte MN assay.

Curvilinear relations between age and hemostatic parameters in Chinese

The role of hemostatic factors in the pathogenesis of cardiovascular disease has gained much attention recently. Information about hemostatic factors, and their age patterns is sparse for orientals. With the data collected in the Cardiovascular Disease Risk Factor Two-township Study in Taiwan, this study shows that, in general, the older the age, the stronger the tendency toward thrombosis. With advancing age, prothrombin time, activated partial thromboplastin time, and antithrombin-III level decreased steadily; but mean values of fibrinogen, factor VIIc, and factor VIIIc increased. Gender differences in the age patterns of the above factors are carefully described. Curvilinear relations between hemostatic factors and age were demonstrated for adults aged 18 and above for all hemostatic factors studied. This curvilinearity should be taken into consideration when adjusting for the effect of age in data analysis to avoid residual confounding, particularly when the age range of the study subjects is wide.

A method for simultaneous identification of human active and active-site alkylated O6-methylguanine-DNA methyltransferase and its possible application for monitoring human exposure to alkylating carcinogens

Cells resist the major mutagenic effects of alkylating agents by the action of O6-methylguanine-DNA methyltransferase (MGMT), which transfers the alkyl (R) group of O6-alkylguanine, produced in DNA by these chemicals, to a cysteine residue in its active site (formation of R-MGMT). We demonstrate that cellular R-MGMT (which represents a record or memory within the cells exposed to these chemicals) can be assayed by its sensitivity toward proteolysis by protease V8. The possible use of this assay for monitoring exposure to alkylating carcinogens was investigated by using cultured cells and a preliminary study with the use of human blood from normal subjects and patients undergoing chemotherapy. Cultured cell experiments show that R-MGMT is sufficiently stable for the monitoring purpose and its level bears a dose-response relationship to the concentrations of the alkylating agent used. Interestingly, experiments with blood from patients undergoing chemotherapy show a gradual formation of R-MGMT in 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea and an induced MGMT deficiency in cyclophosphamide-treated patients. The use of this methodology, which allows for the possible quantification of active MGMT (cellular DNA repair capacity) and R-MGMT (recent exposure) simultaneously, in monitoring human exposure to alkylating carcinogens is discussed.

Seroprevalence and associated risk factors of Helicobacter pylori infection in Taiwan

In order to estimate the seroprevalence and explore multiple risk factors associated with Helicobacter pylori infection among residents in Taiwan, a total of 823 subjects randomly selected from one metropolitan precinct and three townships were studied. Serum samples were tested for IgG antibodies against H. pylori by enzyme-linked immunosorbent assay using commercial kits. The overall seropositive rate was 54.4% with no gender difference (53.7% for males and 55.2% for females). There was a significant geographical variation with the highest seropositive rate (63.4%) in rural area where aborigines live, and where the age-adjusted stomach cancer mortality is highest and the lowest (40.5%) in urban area where Hakkas live, and where the stomach cancer mortality is lowest. There was also an increasing seropositive rate with age from 27.1% for children younger than 10 years old to 72.3% for adults aged more than 40 years old. Age-specific seroprevalence in Taiwan is higher than that in United States, France, Finland and Australia, and lower than that in Algeria, Ivory Coast and India. No association with H. pylori seropositivity was observed for drinking water source, toilet type, family income and educational level after adjusting for age and area. A dose-response relation between H. pylori seropositivity and sibship size was found. Upon further analysis of seroprevalence for children aged 16 or younger, a positive association was observed for birth order and current number of children in family; there was also an inverse association for current number of adults in family. The early childhood transmission among siblings seems an important determinant of H. pylori seropositivity in Taiwan.

Mucosal recipient-type mononuclear repopulation and low-grade chronic rejection occur simultaneously in indefinitely surviving recipients of small bowel allografts

Lewis rat recipients of long-term, surviving, orthotopic Brown-Norway rat intestinal allografts, initially treated with cyclosporin A (CyA) or FK 506, were evaluated for their functional capacity and morphology over 1 year after the immunosuppressive therapy had been discontinued. Functional parameters such as nitrogen and fat balances, maltose absorption, blood chemistry, hematologic studies, and the weight gained by the allografted animals did not differ from those of syngeneically grafted or age-matched normal animals. Immunohistochemical studies showed that the lamina propria of the allografts was repopulated with recipient MHC class II+ mononuclear cells and that a normal distribution of T helper, T suppressor/killer, and IgA+ plasma cells had occurred. However, fibrous replacement of the mesenteric lymph nodes and Peyer's patches were detected in all, and an inflammatory obliterative arteriolopathy developed in the mesenteric vasculature of half of the allografted animals. No such findings were observed in recipients of syngeneic grafts. These results demonstrate that the limited use of potent immunosuppressive agents immediately after transplantation averts rejection and is followed by recipient-type mucosal lymphocytic repopulation. Simultaneously, a clinically not recognizable chronic rejection evolves. This suggests that the timely diagnosis of chronic rejection may not be possible with the use of standard tests of gut function and random mucosal biopsies alone.

Mucosal glutaminase activity and histology as parameters of small bowel preservation injury

The present study in Lewis rats was designed to assess the predictive value of the mucosal enzyme activities of glutaminase, maltase, and xanthine oxidase and of histology as parameters to delineate the degree of small bowel preservation injury. Small bowel grafts were flushed with saline or a modified phosphate-buffered sucrose (PBS) solution, stored at 8 degrees C for 1, 6, or 12 hr, and transplanted heterotopically. Tissue samples for determination of mucosal enzyme activities were taken after the cold storage period, 20 min after reperfusion and 2 and 7 days postoperatively. Biopsies for light microscopic evaluations were obtained at the same time points, but not after cold storage. Glutaminase activity was well maintained after cold storage, regardless of the duration of preservation. Enzyme activities measured 20 min after reperfusion decreased with increasing duration of preservation (saline: R2 = 32.8%; P < 0.01; PBS: R2 = 52.3%; P < or = 0.001) and with increasing histologic preservation injury. Glutaminase activities were predictive for survival of grafts preserved with the PBS solution (R2 = 49.6%; P < or = 0.001; sensitivity 92%; specificity 100%), while the activities of maltase and of xanthine oxidase failed to do so. The degree of histologic preservation injury seen in graft specimens obtained 20 min after reperfusion was a good predictor of graft survival with a sensitivity of 90% for saline-preserved grafts and 92% for PBS-preserved grafts and a specificity of 88 and 67%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Seroprevalence study of Helicobacter pylori infection in patients with gastroduodenal diseases

To investigate Helicobacter pylori (H. pylori) infection in subjects with and without gastroduodenal diseases in Taiwan, IgG antibodies to H. pylori were examined in 136 healthy volunteers, 101 patients with non-ulcer dyspepsia, 122 gastric ulcers, 119 duodenal ulcers, and 161 gastric adenocarcinomas. The seropositivity was highest in duodenal ulcers (87.4%) (p < 0.001, as compared to healthy volunteers), followed by gastric ulcers (76.2%) (p < 0.01, as compared to healthy volunteers), but similar among gastric adenocarcinomas (60.3%), healthy volunteers (58.8%), and patients with non-ulcer dyspepsia (55.5%). Higher acquisition of H. pylori in younger patients with duodenal and gastric ulcers suggests a strong association with H. pylori. No ulcer characteristics, including number, location, and activity, were significantly statistically associated with the seropositivity of H. pylori in gastric and duodenal ulcers. Similarly, the location, extent of invasion, and histology of gastric adenocarcinoma was not significantly statistically associated with the seropositivity of H. pylori.

Role of transesophageal echocardiography in the diagnostic assessment of cardiac sources of embolism in patients with acute ischemic stroke

To evaluate the role of transesophageal echocardiography (TEE) in the diagnostic assessment of cardiac sources of embolism in acute ischemic stroke, 94 consecutive patients (44 men and 50 women, aged 22-82 years) with acute ischemic stroke were prospectively studied. Of these, 34 patients had clinical evidence of heart disease. Both transthoracic and transesophageal echocardiograms were recorded on the same day for each patient. Transthoracic echocardiography (TTE) identified a possible cardiac source of embolism in 2 patients (6%) with and in 3 (5%) without clinical heart disease. TEE identified a possible cardiac source of embolism in 21 patients (62%) with and in 18 (30%) without clinical heart disease. TEE was superior to TTE for the detection of a cardiac source of embolism in patients with acute ischemic stroke (41 vs. 5%, p < 0.001). Factors significantly associated with a greater likelihood of such cardiac sources of embolism included left atrial enlargement, atrial fibrillation and a younger age. The yield of TEE in identifying a possible cardiac source of embolism was higher in patients with clinical evidence of heart disease than in those without.

Radiation dose-dependent variations of micronuclei production in cytochalasin B-blocked human lymphocytes

Using the cytokinesis-block technique, lymphocytes from healthy volunteers (n = 9) were evaluated for 1) the radiation dose-response curve for micronuclei (MN) expression; 2) technique variables on the yield of MN; and 3) the shortest lymphocyte incubation time required for the MN assay. We found that the best fitting of relationships between increasing MN production and increasing irradiation dose (0-4.0 Gy) was the linear-quadratic model as expressed by the yield equation Y = C+alpha D+beta D2 (P = 0.0003). When lymphocytes were irradiated in vitro with 2.0 Gy and harvested at various time intervals, MN increased during the entire 84 hr culture time. The radiation caused a division delay in lymphocyte as indicated by an increased frequency of mononucleated cells and a decreased number of mitotic indices. The data showed that a shortened culture time (60 hr) for the MN assay is possible and that binucleated cells with > or = 3 MN were found only in cells irradiated at > or = 2.0 Gy. These findings suggest that scoring of MN in lymphocytes may be a practical biological dosimeter for the rapid screening of accidental radiation exposure victims, especially when their clinical manifestations are not obvious.

The anatomy of Nikyo (Aikido's second teaching)

Nikyo is the second teaching of Aikido (ni-two, kyo-teaching, in Japanese). It is a joint-lock technique that results in extreme pain. It allows one to control an opponent by destroying his will to continue fighting. Nikyo is accomplished by flexing and adducting an opponent's wrist producing an instantaneous sharp pain that causes him to fall to his knees involuntarily to alleviate the pressure. The exact etiology of the pain elicited by this technique has been obscure to many practitioners. The usual explanations have been nerve compression, joint capsular stretch, tendon/muscle strain, or partial ligamentous disruption. Studies of a cadaver's wrist have shown that Nikyo forcibly compresses the pisiform bone against the ulna, two bones that do not normally articulate. The intense pain thereby produced results from stimulation of the periosteal nerves in these bony surfaces.

Helicobacter pylori infection in a randomly selected population, healthy volunteers, and patients with gastric ulcer and gastric adenocarcinoma. A seroprevalence study in Taiwan

To investigate the association of Helicobacter pylori and gastric ulcer and adenocarcinoma, IgG antibodies against H. pylori were examined in 823 randomly selected subjects, 92 healthy volunteers, 117 patients with gastric ulcer, and 148 with gastric adenocarcinomas in Taiwan, where the prevalence of gastric adenocarcinoma is high. The seropositivity of this population in Taiwan was 54.4%. Gastric ulcer patients had a higher seropositivity (83.8%) than healthy volunteers (62.0%) and gastric adenocarcinoma patients (62.2%) (P < 0.001). Gender difference, blood type, and habit of smoking were not associated with the seroprevalence in any study groups. Gastric ulcer coexistent with duodenal ulcer had a higher seropositivity (94.7%) (P < 0.05). The seropositivity of H. pylori in gastric adenocarcinoma patients was higher than in healthy volunteers only in younger age and was not associated with histologic type, invasion, and location of major tumors. The results reemphasize the association of H. pylori infection with gastric ulcer but not with gastric adenocarcinoma in Taiwan.

Occlusive and reperfused myocardial infarction: detection by using MR imaging with gadolinium polylysine enhancement

PURPOSE

To assess the capability of gadolinium polylysine-enhanced cardiac magnetic resonance (MR) imaging in depicting normal and ischemic myocardium during occlusion and reperfusion of the left anterior descending artery.

MATERIALS AND METHODS

Contrast-enhanced MR images were obtained in 18 cats during 90 minutes each of occlusion and reperfusion. The change in signal intensity (SI) was compared among normal myocardium and central and peripheral ischemic zones. Results were compared with those of 2,3,5-triphenyltetrazolium chloride staining.

RESULTS

During occlusion, the ischemic zone lacked enhancement while normal myocardium had gradual enhancement. During reperfusion, the ischemic zone had strong enhancement. In cats with large infarction, the central and peripheral ischemic zones had intermediate and high SI, respectively; in cats with focal or no infarction, the entire ischemic zone had high SI.

CONCLUSION

Occlusive and reperfused myocardial infarction can be detected at gadolinium polylysine-enhanced MR imaging by means of differential SI changes in normal myocardium and central and peripheral ischemic zones.

Variations associated with disaggregation methods in DNA flow cytometry

We investigated the variations in DNA ploidy by flow cytometry (FC) among cell suspensions acquired by different disaggregation methods from the same tumor specimens. Cell suspensions (n = 121) of 40 solid tumors were obtained by mechanical mincing (n = 33), enzymatic digestion (n = 19), in vitro fine needle aspiration (FNA) (n = 34) or scraping (n = 35) of the tumor tissues. Mechanical disaggregation gave the highest cell yield, whereas enzymatic digestion provided the best cell viability. The mean values for the G0/G1 coefficient of variation, DNA indices and percent S phase were not significantly different in cell suspensions obtained with the four methods. However, the yield of malignant cells ranged from 60.4 +/- 5.3% (SEM) (enzymatic) to 82.3 +/- 3.1% (scraping). Tissue aliquots of 32 tumors were disaggregated by three to four methods, and the combined results of DNA ploidy obtained from different cell preparations showed that 22 tumors were nondiploid, but concordance with an abnormal DNA peak was found in only 27.3% (6/22) of the DNA nondiploid tumors. Our results indicate that scraping tumor tissue appears to be the best method for DNA FC since it has the highest percentage (61.3) of DNA nondiploid clones. Also, we believe the multiple samplings may provide comprehensive information on the DNA ploidy of solid tumors.

Combined use of aspirin and heparin inhibits in vivo acute carotid thrombosis

BACKGROUND AND PURPOSE

Carotid atherosclerotic thrombosis is an important cause of ischemic stroke in Western countries. The therapeutic efficacy of either aspirin or heparin alone in this setting is still controversial. Recently we developed a simple model, the "clamp" method, to induce acute carotid mural thrombosis in vivo in guinea pigs. In this study, we used this model to evaluate the antithrombotic effects of aspirin, heparin, and their combination.

METHODS

Sixty-four male guinea pigs were divided equally into control, aspirin, heparin, and combined groups. Physiological saline, aspirin (5 mg/kg body wt), heparin (200 units/kg body wt), or a combination of aspirin and heparin, respectively, was injected via the jugular vein before the use of the clamp method. Thirty minutes after the injection of saline or drug(s), Péan's forceps was used to clamp the carotid artery at a tangent angle for 3 minutes. One hour later, the carotid artery was resected and prepared for observation under a scanning electron microscope or light microscope to evaluate the degree of mural thrombosis.

RESULTS

The results showed that the combination of aspirin and heparin had an excellent effect in inhibiting in vivo acute carotid thrombosis (p < 0.001) and was significantly better than the effect of aspirin alone (p < 0.01) or heparin alone (p < 0.01).

CONCLUSIONS

Our study clearly demonstrated that the combined use of aspirin and heparin produced a much better antithrombotic effect than either agent alone at sites of carotid endothelial injury when given before the injury. This combined regimen may be useful clinically in acute carotid thrombosis secondary to carotid diseases or carotid endarterectomy.

Recovery from aphasia and conversion of handedness: a case report

A remarkably rapid and complete recovery from aphasia and conversion from right to left handedness was documented in a hemiplegic individual after surgery for an arteriovenous malformation (AVM) in the dominant hemisphere. The possible mechanisms of recovery were discussed and we have reviewed the literature about the pattern of cerebral dominance. Her rapid recovery could be explained by the co-dominance of the right and left cerebral hemispheres.

Is health care different? Popular support of federal health and social policies

Over the past several years there has been a striking increase in policymakers' attention to health care reform. This paper explores whether there has been a corresponding shift in popular attitudes and identifies factors that may have changed these attitudes. The first part of the analysis relies on survey data collected between 1975 and 1989 to estimate a set of regression models, relating support for federal involvement in health care, antipoverty programs, and general domestic policies to a set of sociodemographic characteristics. Relative to other federal policies, support for health initiatives grew over this period. During the same period, long-standing differences in support between rich and poor, old and young, educated and uneducated, all narrowed for health care, though they did not for other types of federal policies. The second part of this study explores motivations that might account for these patterns. We identify a half dozen ways in which health care may be viewed as "different," that is, more or less appropriate for federal action. Analysis of survey data from 1987 suggests that there are relatively small differences in the attitudes and perceptions that motivate support for federal health initiatives, relative to federal domestic policies in general. However, there are more striking differences between health programs and more overtly redistributive policies. Compared to redistributive federal programs, support for federal health initiatives are (a) less identified with racial minorities or economically disadvantaged groups, (b) less constrained by notions of individual responsibility, (c) more closely associated with concerns about equal opportunity in American society, and (d) somewhat more constrained by choices between federal and local government. These patterns persist whether or not respondents are politically active and whether they report themselves to be liberal or conservative. We suggest that the growing support for federal intervention in health care, relative to other social policies, is in part an inadvertent by-product of ideological positions popularized during the Reagan and Bush administrations. We draw from these results some predictions about the course of the ongoing debate over federal health policies.

Pathogenesis of pancreatic sepsis

Although pancreatic sepsis is the most common cause of major morbidity and mortality associated with acute pancreatitis, the pathogenesis of such infections is unknown. Since intraperitoneal foci of inflammation are known to promote bacterial translocation, we hypothesized that acute pancreatitis promotes bacterial translocation that leads to infection of the inflamed pancreas and peripancreatic tissues. Non-lethal acute pancreatitis was induced in rats, and the translocation of live bacteria to the pancreas, mesenteric lymph nodes, liver, and spleen was determined. The presence of orally fed fluorescent beads, sensitive inert markers of translocation, was also determined in the pancreas and mesenteric lymph nodes. Live bacteria were recovered from 33% of the pancreata of rats with acute pancreatitis but from none of the control rats. Beads were visualized in 91% of the pancreata of rats with acute pancreatitis but in none of the pancreata from control rats. Beads were not visualized in the mesenteric lymph nodes of rats with acute pancreatitis, suggesting a transperitoneal route of migration. We conclude that acute pancreatitis promotes bacterial translocation leading to transperitoneal infection of the pancreas. These results support the use of selective decontamination of the gut and peritoneal lavage for the prevention of pancreatic infections in acute pancreatitis.

Successful treatment of ongoing intestinal allograft rejection permits recovery of graft structure and function

Acute rejection episodes often complicate clinical small bowel transplantation, which prompted us to investigate whether such episodes can be reversed and the intestinal graft salvaged. Inbred Lewis rats that received fully allogeneic Brown-Norway small bowel allografts were treated with cyclosporin A (10 mg/kg) for 5 days, and the drug was then discontinued. Clinical and histologic signs of acute rejection developed, and the animals were subsequently treated with FK 506 (2 mg/kg) on days 14, 16, and 18. Survival was significantly prolonged (201.7 +/- 46.8 days) when compared with animals that were not administered FK 506 (16.5 +/- 0.8 days) or allograft recipients that received no immunosuppressive therapy (10.8 +/- 0.7 days). The histologic changes and functional impairment due to rejection that were observed prior to the start of the FK 506-therapy were reversed. However, biopsy specimens of all animals exhibited features of chronic rejection. This study provides evidence that acute rejection of intestinal allografts can be successfully treated with a short course of FK 506.