The effect of selenium supplementation on skeletal and cardiac muscle in selenium-depleted patients

BACKGROUND

The purpose of the present study was to evaluate the effect of sodium selenite on skeletal and cardiac muscular function in patients with severe Se deficiency.

METHODS

Skeletal and cardiac muscular function was investigated in 10 selenium depleted patients on long-term home parenteral nutrition because of short bowel syndrome. The following examinations were applied: Skeletal muscle biopsy, muscular force test (Kin-Com dynamometer test), electromyography (EMG) and radionuclide ventriculography. The patients were blindly randomized to intravenous supplementation with selenium 200 micrograms 5 to 7 times per week or placebo for 4 months. Hereafter the examinations were repeated. The patients randomized to placebo received selenium in an open study for a further 4 months and hereafter their skeletal and cardiac function was reevaluated.

RESULTS

Plasma selenium increased to normal levels from median .21 mumol/l (range 0-.69) to 1.25 mumol/l (range .9-2.27) following selenium repletion. The muscle biopsies showed only minor abnormalities. The only change after selenium supplementation was a small but statistically significant increase of the mean diameter of fiber type 1. The muscle strength of the quadriceps muscle was unchanged after selenium substitution. EMG did not reveal signs of myopathy. The cardiac function was normal and remained unchanged.

CONCLUSION

Despite severe selenium depletion ten patients on long term home parenteral nutrition had normal cardiac function, and no clinically significant signs of skeletal myopathy. The only change after selenium supplementation was a small but statistically significant increase of the mean diameter of muscle fiber type 1.

Effect of rectal dilation in fecal incontinence with low rectal compliance. Report of a case

PURPOSE

This study was undertaken to determine the effect of rectal dilation in a patient with urge-type fecal incontinence and frequent bowel movements associated with low rectal compliance and capacity.

METHOD

Daily rectal balloon dilation was performed for a period of four weeks.

RESULTS

The patient regained complete fecal continence with one to two daily bowel movements. Rectal compliance, capacity, and cross-sectional area increased by 37 to 136 percent. Nine months later the patient was still without symptoms.

CONCLUSION

Rectal balloon dilation may be a therapeutic alternative in selected patients.

Rate and treatment of pelvic recurrence after abdominoperineal resection and low anterior resection for rectal cancer

PURPOSE

This study was designed to analyze factors of importance for local recurrence after radical surgery for rectal cancer and to analyze course and outcome of treatment of pelvic recurrence.

METHODS

One hundred seventy-five patients treated for rectal cancer with low anterior resection (LAR) or abdominoperineal resection (APR) were studied, retrospectively. Seventy-four patients had LAR and 101 had APR.

RESULTS

The two groups were comparable with respect to Dukes classification, histologic differentiation, and male to female ratio. The rate of pelvic recurrence was 18 percent for LAR and 24 percent for APR (not significant). Recurrence rates were 27 percent after stapled anastomoses and 10 percent after handsewn anastomoses respectively (P = 0.09). Twenty five had pelvic recurrence diagnosed without signs of distant metastatic disease. They were treated with radiotherapy, palliative operations, or analgesics. The group receiving radiotherapy had a significantly longer survival (15.9 months) compared with other groups (2.4 months; P < 0.001).

CONCLUSIONS

There is no difference in local recurrence rate after LAR and APR. Radiotherapy seems to increase survival in patients with an unresectable recurrence and should be offered irrespective of pain.

Bilateral gluteus maximus transposition for anal incontinence

Seven patients (five women and two men) with anal incontinence in whom previous surgery had failed, were treated by bilateral gluteus maximus transposition. All patients were incontinent to solid stool. Previous surgery was postanal repair in four women and secondary overlapping suture for obstetric tear in one. The two men were treated in childhood for anal atresia. No covering stoma was used. Wound infection occurred in three patients, requiring surgical drainage in two. After follow-up of more than 1 year three patients experienced improved continence but in four continence was unchanged. Anorectal physiology studies showed moderately increased resting and squeeze pressures in patients who were improved by the operation, but none could retain more than 200 ml of viscous fluid instilled into the rectum. No change in rectal sensitivity or volume tolerance was found. This preliminary series does not indicate that better results are obtained by gluteus maximus transposition than by unstimulated graciloplasty.

Pudendal nerve damage increases the risk of fecal incontinence in women with anal sphincter rupture after childbirth

AIM

To evaluate anal function after childbirth in 94 women in whom sphincter rupture occurred and in 19 control women. The findings of anorectal physiological assessment and history of childbirth were related to the presence of fecal incontinence.

METHODS

Anal manometry and electromyography were performed the first days after childbirth and repeated 3 months post partum together with measurement of pudendal nerve terminal motor latency.

RESULTS

Eighteen patients (19%) presented with incontinence. None of the controls developed fecal incontinence after delivery. Anal manometry showed that both incontinent and continent patients had decreased resting and squeeze pressures compared to control subjects (p < 0.005). No difference in anal electromyography was found between the three groups. Both anal manometry and electromyography showed a significant increase in pressure and activity respectively 3 months after delivery in patients and controls. Patients with pudendal nerve terminal motor latencies > 2.0 milliseconds had an increased risk of having fecal incontinence compared to patients with pudendal nerve terminal motor latencies < or = 2.0 milliseconds (odds ratio 2.18, p < 0.05). Fecal incontinence could not be related to the weight or head circumference of the infant. The manometric and electromyographic findings, the use of pudendal nerve block, the length of the second stage of labor, the depth of rupture or the use of vacuum extraction could not be related to either fecal incontinence or pudendal nerve function.

CONCLUSION

The manometric findings indicated damage to the anal sphincter apparatus in both continent and incontinent patients. Decreased pudendal nerve function characterized incontinent women. Accurate prediction of fecal incontinence in women with obstetric anal sphincter rupture is not possible.

Dissemination in athymic nude mice of lacZ transfected small cell lung cancer cells identified by X-gal staining

The small cell lung cancer cell lines GLC-2 and DMS 456 were genetically labeled with the lacZ gene and examined for invasive and metastatic potential in META/Bom nude mice. The lacZ gene encodes the enzyme beta-D- galactosidase, and cells expressing this enzyme were identified by staining with the chromogenic substrate X-gal. lacZ expressing cells were investigated after subcutaneous (s.c.) inoculation and intravenous (i.v.) injection. The X-gal detection of beta-D-galactosidase activity proved to be a rapid and easy means for specific and highly sensitive identification of metastases. All primary s.c. tumors stained by X-gal. The primary tumors of GLC-2 regularly demonstrated local invasive growth and produced multiple metastases in several organs. In contrast, primary DMS 456 tumors only occasionally demonstrated local invasion and very rarely generated secondary foci. No experimental metastases were found after i.v. injection of the examined tumor lines. The results indicate an intratumoral heterogeneity among individual SCLC tumors in the capacity for invasion and metastatic spread. The different metastatic pattern of GLC-2 after s.c. and i.v. inoculation supports the hypothesis that initial steps of the metastatic cascade occurring in the primary tumor are necessary for the subsequent production of growing metastases.

Treatment of internal rectal intussusception in patients with chronic constipation

BACKGROUND

The significance of internal rectal intussusception (rectal invagination) in chronic constipation dominated by symptoms of obstructed defecation is not fully clarified.

METHODS

Seventeen consecutive patients with chronic constipation and a history of obstructed defecation with internal rectal intussusception demonstrated by defecography were treated by perineal rectopexy.

RESULTS

Of 15 patients followed up for more than 2 years defecography showed total disappearance of the intussusception in 12. Five of these claimed substantial improvement (42%; 17-72%). Three of four patients with concomitant anal incontinence became fully or partly continent after the rectopexy.

CONCLUSION

In some patients with chronic constipation, dominated by symptoms of obstructed defecation, rectal invagination may be an aggravating factor. The study indicates that rectal invagination does not seem to be the cause but rather a consequence of the obstructed defecation. In selected patients, including those with concomitant faecal incontinence, surgical treatment of the intussusception by a minor procedure may be indicated.

Observer variability in the assessment of type and dysplasia of colorectal adenomas, analyzed using kappa statistics

PURPOSE

The aim of this study was to establish the intraobserver and interobserver variability in the assessment of histologic type (tubular, villous, and tubulovillous) and grade of cytologic dysplasia (mild, moderate, and severe) in colorectal adenomas.

METHODS

One hundred eighty-seven slides of adenomas were assessed twice by three experienced pathologists, with an interval of two months. Results were analyzed using kappa statistics.

RESULTS

For agreement between first and second assessment (both type and grade of dysplasia), kappa values for the three specialists were 0.5345, 0.9022, and 0.4100, respectively. Agreement was better for type than for dysplasia. The strength of agreement was moderate for Observers A and C and almost perfect for Observer B. Agreement between all three observers was seen in 35.2 percent for both type and dysplasia in 61 percent for type and in 47.8 percent for dysplasia. The kappa values for Observer A vs. B and Observer C vs. B were 0.3480 and 0.3770, respectively (both type and dysplasia). Values for type were better than for dysplasia, but agreement was only fair to moderate.

CONCLUSION

The interobserver agreement was moderate to almost perfect, but the intraobserver agreement was only fair to moderate. A simpler classification system or a centralization of assessments would probably increase kappa values.

The Sry-related gene Sox9 is expressed during chondrogenesis in mouse embryos

Mutations in the human SRY-related gene, SOX9, located on chromosome 17, have recently been associated with the sex reversal and skeletal dysmorphology syndrome, campomelic dysplasia. In order to clarify the role of this gene in skeletal development, we have studied the expression of mouse Sox9 during embryogenesis. Sox9 is expressed predominantly in mesenchymal condensations throughout the embryo before and during the deposition of cartilage, consistent with a primary role in skeletal formation. Interspecific backcross mapping has localized mouse Sox9 to distal chromosome 11. The expression pattern and chromosomal location of Sox9 suggest that it may be the gene defective in the mouse skeletal mutant Tail-short, a potential animal model for campomelic dysplasia.

Rectal compliance determined by rectal endosonography. A new application of endosonography

PURPOSE

The aim of this study was to develop a method for determination of rectal compliance that allows direct measurement of corresponding changes in the rectal cross-sectional area or perimeter and rectal pressure.

METHODS

We developed an anal probe for transrectal endosonography. The probe was tested in vitro, and rectal compliance of six healthy patients was determined.

RESULTS

In vitro measurements proved the method to be well reproducible. The method allowed calculation of an endosonographic rectal compliance, which correlated well with rectal compliance measured by the standard method.

CONCLUSION

Endosonographic determination of rectal compliance is possible, and the endosonographic method may give a more precise and reproducible estimation of rectal compliance.

Treatment of recurrent high anal fistula by total excision and primary sphincter reconstruction

Fourteen patients with recurrent high anal fistula were treated by total excision of the fistulous tract with primary sphincter reconstruction. Nine patients with sepsis had seton drainage for one to three months before the operation. The surgical approach was the transsphincteric technique described by Mason. No covering stoma was used routinely, but three patients referred with a colostomy had the stoma closed 3 to 5 months later. After a follow-up from 1 to 4 years two patients had recurrence, which in one necessitated a diverting ileostomy. Three patients, one with recurrence and two without, suffered from minor anal incontinence. It is concluded that total excision with primary sphincter reconstruction is a treatment modality which should be considered for recurrent high anal fistula, especially in patients where closure by an advancement flap is not possible.

A guanosine quadruplex and two stable hairpins flank a major cleavage site in insulin-like growth factor II mRNA

Insulin-like growth factor II (IGF-II) mRNAs are cleaved by an endonucleolytic event in a conserved part of their 3' untranslated region that is predicted to exhibit a complex higher-order RNA structure. In the present study, we have examined the putative secondary structures of in vitro transcripts from the conserved part of human and rat mRNAs by enzymatic and chemical probing. The results show that the cleavage site is situated between two highly structured domains. The upstream domain consists of two large hairpins, whereas the downstream domain is guanosine-rich. The guanosine-rich domain adopts a compact unimolecular conformation in Na+ or K+ but not in Li+, and it completely arrests reverse transcription in K+ but only partially in Na+, indicating the presence of an intramolecular guanosine quadruplex. The flanking higher-order structures may ensure that the cleavage site is not sequestered in stable RNA structures, thus allowing interactions with RNA or proteins at posttranscriptional stages of IGF-II expression.

Purification and characterization of the bovine pituitary luteinizing hormone releasing hormone M(r) 60,000 binding protein

Luteinizing hormone releasing hormone (LHRH) regulates the release of luteinizing hormone and follicle stimulating hormone from the pituitary. This process takes place through interaction with high affinity membrane receptors. In addition LHRH inhibits the growth of several cancer cell lines through the interaction with M(r) 60,000 LHRH receptors. Here we describe the purification to homogeneity of the M(r) 60,000 bovine pituitary LHRH binding protein in amounts allowing N-terminal sequencing and peptide mapping. The procedure describes solubilization of luteinizing hormone releasing hormone receptors from homogenized bovine pituitaries in an active form by using the detergent Triton X-114. The receptors were retained in the Triton X-114 phase during temperature-dependent phase separation. Preparative phase separations were performed directly on solubilized bovine pituitary extracts. SDS-PAGE of the purified LHRH receptor after LHRH-immobilized affinity chromatography showed the presence of a single band with M(r) 60,000. Partial sequencing of this band after trypsin digestion of gel pieces revealed unknown sequences with a possible homology to other receptors including some G-protein coupled receptors.

[Treatment of complicated forms of anal incontinence]

In recent years, several techniques for the treatment of more complex forms of faecal incontinence have emerged. These consist of either transposition of skeletal muscle (gracilis muscle or gluteus maximus muscle) around the anal canal, implantation of an artificial sphincter or implantation of a neuromuscular stimulator having previously transposed gracilis muscle. The latter method seems to hold most promise.

Spinach carbonic anhydrase: investigation of the zinc-binding ligands by site-directed mutagenesis, elemental analysis, and EXAFS

The enzyme carbonic anhydrase has been well characterized in mammalian systems, but the structural properties of the plant isozymes remain elusive. To investigate the nature of the zinc-binding site in spinach carbonic anhydrase, we targeted potential zinc ligands for mutagenesis and examined the resulting enzymes for catalytic activity and stoichiometric zinc binding. In addition, we examined the wild-type protein using extended X-ray absorption fine structure analysis. Our results suggest that spinach carbonic anhydrase utilizes a Cys-His-Cys-H2O ligand scheme to bind the zinc ion at the active site.

Isolation and genetic mapping of two novel members of the murine Wnt gene family, Wnt11 and Wnt12, and the mapping of Wnt5a and Wnt7a

The murine Wnt genes are implicated in the control of a variety of developmental processes. Using a PCR-based approach, we have isolated two novel members of the murine Wnt gene family, Wnt11 and Wnt12. These cDNAs display an amino acid sequence identity of between 38 and 49% with all other murine Wnts over the regions that we have isolated. In addition, two previously described Wnt genes, Wnt5a and Wnt7a, were detected in RT-PCR products. Interspecific crosses were used to demonstrate close linkage between Wnt12 and Wnt1 on Chromosome (Chr) 15. Wnt7a was mapped to mouse Chr 6, Wnt5a to the centromeric region of Chr 14, and Wnt11 to Chr7.

Laparoscopic loop ileostomy for fecal diversion

PURPOSE

The aim of this study was to describe the procedure for laparoscopic loop ileostomy.

METHODS

Technique description is given.

CONCLUSION

The method is suitable for temporary fecal diversion in patients with anal disorders, where no other intraperitoneal operation is required.

Glucagon-like peptide-1 7-36 amide and peptide YY from the L-cell of the ileal mucosa are potent inhibitors of vagally induced gastric acid secretion in man

BACKGROUND

Glucagon-like peptide (GLP-1) 7-36 amide and peptide YY (PYY) from the L-cell of the ileal mucosa are potent inhibitors of gastric acid secretion in man. It is not clear, however, by which mechanism(s) they inhibit acid secretion. In dogs the inhibitory effect of PYY on acid secretion may be mediated mainly through neural pathways. The mechanism of action of GLP-1 might be similar. The aim of the present study was to examine the effects of GLP-1 might be similar. The aim of the present study was to examine the effects of GLP-1 and PYY on the vagally induced gastric acid secretion in man.

METHODS

A modified sham feeding technique, chew and spit, was used. Six healthy volunteers were randomly assigned to receive intravenous infusion of saline, GLP-1 (41 pmol/kg/h), or peptide YY (50 pmol/kg/h).

RESULTS

The infusion of GLP-1 and PYY resulted in plasma concentrations of 60 +/- 9 pmol/l and 84 +/- 11 pmol/l, respectively. GLP-1 and PYY both significantly inhibited the intergrated acid output by 67 +/- 6% and 68 +/- 9%, respectively, compared with the integrated outputs in a control experiment with saline infusion. Serum gastrin and plasma somatostatin concentrations remained unchanged during saline, GLP-1, and PYY infusions.

CONCLUSIONS

GLP-1 and PYY are both potent inhibitors of the cephalic phase of acid secretion, indicating that at least part of the inhibitory effect of GLP-1 and PYY in man is mediated through neural pathways. Furthermore, the inhibitory effect seems to be independent of circulating concentrations of gastrin and somatostatin.

Pharmacological characterization of a biosynthetic trisulfide-containing hydrophobic derivative of human growth hormone: comparison with standard 22 K growth hormone

Growth hormone is the classical anabolic hormone which promotes organ growth after binding to somatogenic target cell receptors, present in various target tissues. The present study elucidated the pharmacological characteristics in vitro and in vivo of human growth hormone and a recently identified by-product of a recombinant human growth hormone preparation; i.e. a trisulfide-containing (cys 182-cys 189) hydrophobic, folding derivative of growth hormone, hydrophobic derivative-growth hormone. Standard growth hormone and hydrophobic derivative-growth hormone possessed similar characteristics in vitro, both as regards binding to the somatogenic receptor on the human IM-9 cell line, and the prolactin receptor-mediated proliferation of rat Nb2 cells. This indicates that no change occurs in the binding characteristics in spite of a change in conformation of the molecule. Using an ELISA assay that detected standard and hydrophobic derivative-growth hormone equally well, the plasma pharmacokinetical profiles of the preparations following a single intravenous or subcutaneous dose were indistinguishable. Thus, following initial disposition of hydrophobic derivative-growth hormone and standard growth hormone into a volume, V1, of one to two times the plasma volume, almost 90% of either compound disappeared from plasma during the alpha-phase of the plasma decay curve. Similar half-lives of 4-5 min. were found for hydrophobic derivative-growth hormone and standard growth hormone during this phase, indicating rapid removal of drug from the circulation. Also, the AUC and Cmax values for standard and hydrophobic derivative-growth hormone did not differ following intravenous or subcutaneous administration.(ABSTRACT TRUNCATED AT 250 WORDS)

[Sphincter rupture in the course of labor]

Thirty-eight women with anal sphincter rupture during childbirth were followed for three to 12 months. Fourteen patients presented with continence disturbances, nine to solid or fluid faeces and five to gas. Incontinence was present in nine patients three months after childbirth. Anal manometry and anal electromyography were performed on the patients three to five days after delivery and repeated at three, six and twelve months after childbirth. Manometry and electromyography were performed on 16 control subjects and 24 primiparous control patients who were investigated three to five days and three months after delivery. Anal manometry and anal electromyography showed significant differences between both incontinent and continent patients compared to control subjects and primiparous control patients. Primiparous control patients had decreased squeeze pressure as well as decreased electromyographic activity during the first days after delivery compared to control subjects. After three months no differences were found. Continence disturbances are frequent after sphincter rupture and these patients should be monitored after delivery and those with persisting incontinence offered sphincter repair.

Insulin-like growth factor II mRNA, peptides, and receptors in a thoracopulmonary malignant small round cell tumor

Insulin-like growth factor-(IGF) II and IGF-I and IGF-II/mannose 6-phosphate receptors were expressed in a thoracopulmonary malignant small round cell tumor (MSRCT) from a 14-year-old boy. Northern analysis showed that the MSRCT expresses multiple IGF-II mRNA of 6.0, 4.8, 4.2, and 2.2 kilobase from promoters P3 and P4 of the human IGF-II gene. Chromatography and radioimmunoassay revealed two forms of IGF-II with molecular masses of 7.5 kilodalton (kDa) and 10 kDa, corresponding to mature IGF-II and IGF-II with a C-terminal extension, in concentrations of 61 and 41 ng/g/tumor tissue, respectively. By a combined reverse transcription-polymerase chain reaction analysis, the authors also show that the MSRCT expresses IGF-I and IGF-II/mannose 6-phosphate receptor mRNA. The plasma concentration of IGF-II was 600 ng/ml and within the normal range of serum IGF-II. IGF binding proteins (IGFBP) of 41.5, 38.5, 34, 30, and 24 kDa were present in serum. Compared with normal plasma from healthy subjects and an age-matched group of boys, the level of the 41.5, 38.5, and 30 kDa IGFBP were approximately 3-fold elevated. The authors conclude that transcription of the IGF-II gene leads to the production of significant amounts of 10 kDa IGF-II and 7.5 kDa IGF-II. IGF-II may stimulate the proliferation of MSRCT by interaction with IGF-I receptors on the cells.

Electromyography of the internal anal sphincter performed under endosonographic guidance. Description of a new method

PURPOSE

The aim of our study was to investigate internal anal sphincter electromyographic signals.

METHODS

Electromyography of the internal anal sphincter was performed with platinum wire electrodes in six healthy volunteers (three males and three females), inserted under endosonographic guidance. Platinum wire electrodes were also inserted into the external anal sphincter. Activity of both the internal and external and sphincter in a 40-second period was measured.

RESULTS

Internal anal sphincter median activity was 22.1 (range, 5.5-67.6) microV. Slow-wave activity was 47 cycles/minute (range, 34-55 cycles/minute). After inflation of a rectal balloon with air until a constant relaxation of the anal canal was obtained, a decrease in internal and sphincter activity to 15.9 (1.2-31.3) microV as well as a decrease in slow-wave activity to 34 cycles/minute (range, 27-40 cycles/minute) was found. The original internal anal sphincter EMG was resumed after deflation of the rectal balloon. External anal sphincter median activity was 3.1 (range, 0.77-18.6) microV. During inflation of the rectal balloon, a reflex increase in external sphincter EMG activity was found. With the rectal balloon fully inflated a part of this increase was still present, 11.0 (1.9-24.6) microV. In some of the subjects, this increased activity was superimposed on the internal anal sphincter recordings as well. During a voluntary squeeze it was not possible to identify internal anal sphincter activity due to activity of the external anal sphincter totally overriding the internal anal sphincter signal.

CONCLUSION

Precise EMG recordings from the internal anal sphincter is possible with endosonographic guidance of the electrodes, except during voluntary squeezing of the external and sphincter.

[Anal ultrasonography in anal incontinence]

Endosonography gives detailed information on the internal and external anal sphincters. The goals of this study were to evaluate findings on anal endosonography in patients with anal incontinence and to study the value of endosonography for selecting the most effective surgical treatment. Forty-eight patients with incontinence for either gas (17 patients) or faeces (31 patients) were studied. Nineteen patients had idiopathic incontinence, 29 were incontinent due to previous obstetrical or surgical trauma. Endosonography and measurement of anal canal pressures were performed in all patients, 40 had needle electromyography. The endosonograms were evaluated without knowledge of the clinical findings and correlated with the results of needle electromyography, with the anal pressures, and to the type of surgery subsequently performed. In 30 patients surgery was subsequently planned on the basis of the results of endosonography and the anophysiologic examinations. Endosonograms showed defects in 27 external sphincters, 12 of whom had internal sphincter defects also. One patient had an abnormal thinning of the external sphincter. Eight patients had defects of the internal sphincter as the only finding. Twenty-two of the patients with sonographically detected defects or thinning of the external sphincter had an EMG performed, this showed defects of the external sphincter in 18, four defects in the middle and upper anal canal had not been found. There was no correlation between the sphincteric defects found by endosonography and the anal canal pressures. Sphincter reconstruction was offered to most patients with damage to the external sphincter; patients with isolated defects in the internal sphincter or intact internal and external sphincters were offered a number of other surgical procedures.(ABSTRACT TRUNCATED AT 250 WORDS)