Advances in short bowel syndrome: an updated review

Short bowel syndrome (SBS) continues to be an important clinical problem due to its high mortality and morbidity as well as its devastating socioeconomic effects. The past 3 years have witnessed many advances in the investigation of this condition, with the aim of elucidating the cellular and molecular mechanisms of intestinal adaptation. Such information may provide opportunities to exploit various factors that act as growth agents for the remaining bowel mucosa and may suggest new therapeutic strategies to maintain gut integrity, eliminate dependence on total parenteral nutrition, and avoid the need for intestinal transplantation. This review summarizes current research on SBS over the last few years.

Virucidal activity of a new hand disinfectant with reduced ethanol content: comparison with other alcohol-based formulations

A new formula with reduced ethanol content (55%) in combination with 10% propan-1-ol, 5.9% propan-1.2-diol, 5.7% butan-1.3-diol and 0.7% phosphoric acid exhibited a broad spectrum of virucidal activity. In quantitative suspension tests, with and without protein load, this formulation reduced the infectivity titre of seven enveloped (influenza A and B, herpes simplex 1 and 2, bovine corona, respiratory syncytial, vaccinia, hepatitis B, bovine viral diarrhoea) and four non-enveloped (hepatitis A, polio, rota, feline calici) viruses >10(3)-fold within 30s. In comparative testing, only 95% ethanol showed similar levels of activity. In fingerpad tests, the formulation produced a log10 reduction factor of the titre of poliovirus type 1 (Sabin) of 3.04 in 30s compared with 1.32 by 60% propan-2-ol. Testing against feline calicivirus produced a log10 reduction factor of 2.38 by the test formulation; in contrast, the log10 reduction factors with 70% ethanol and 70% propan-1-ol were 0.68 and 0.70, respectively.

Lavasept® als Alternative für PVP-Iod zur präoperativen Antiseptik in der Ophthalmochirurgie

BACKGROUND

To reduce the risk of endophthalmitis PVP-iodine is typically used preoperatively. Since iodine is contraindicated in patients with a specific allergic history or severe thyroid disorder we studied the effect of Lavasept, which contains Polyhexanid as an antiseptic alternative.

PATIENTS AND METHODS

In a randomized controlled double-blind trial 3 drops of 0.2% Lavasept, 1.25% PVP-iodine or Ringer's solution were applied preoperatively to 67 patients, which have had a minimum of 5 colony forming units (cfu's) in the conjunctival swap. The effectiveness and tolerability were measured.

RESULTS

After application of Lavasept or PVP-iodine, the number of cfu was statistically significantly reduced. Lavasept reduced the number of bacterial colonies significantly better than PVP-iodine (p=0.05). All test solutions were equally well tolerated.

CONCLUSION

The use af Lavasept is safe, well tolerated and reduces the microbiological contamination of the conjunctival fornix effectively. lt provides a more effective reduction of the cfu's than PVP-iodine 1.25% and this effect tends to be prolonged. Lavasept is a good alternative option in ophthalmology for preoperative antisepsis.

Risk Factors for Goiter in a Previously Iodine-Deficient Region

OBJECTIVE

Little information exists from formerly iodine-deficient areas regarding gender-specific risk factors for goiter and their synergisms. The aim of the present study was to investigate such gender-specific risk factors and their interactions in a large population-based sample.

METHODS AND RESULTS

The Study of Health in Pomerania (SHIP) comprised 4310 randomly selected participants, aged 20 - 79 years. SHIP was performed in a previously iodine-deficient region. Data from 3915 participants with no known thyroid disorders were analyzed. Goiter was determined by thyroid ultrasound. Sociodemographic characteristics, smoking and alcohol drinking habits, marital status, education level, urine thiocyanate concentrations, and specifically in women, parity and previous or current use of oral contraceptives and hormone replacement therapy, were considered as candidate risk factors for multivariable statistical tests. Only two variables, an advanced age and current smoking, were independently associated with an increased risk for goiter in both genders. Analyses further revealed specific risk factor profiles for goiter which were different among men, pre- and postmenopausal women.

CONCLUSION

We conclude that besides previous iodine deficiency, other risk factors for goiter exist which differ between gender. Among the avoidable risk factors, current smoking was strongly associated with the risk of goiter in men and women. These findings should influence activities which are intended to prevent thyroid disease.

Prevention and control of health care-associated waterborne infections in health care facilities

The current article is a review of the public health risks attributable to waterborne pathogens in health care. The consequences of health care-associated infections (HAIs) are discussed. Not only are Legionella spp involved in HAIs, but also Pseudomonas aeruginosa, other gram-negative microorganisms, fungi, and amoeba-associated bacteria. This is particularly noteworthy among immunocompromised patients. New prevention strategies and control measures brought about through advanced planning, facility remodelling and reconstruction, disinfection, and filtration have resulted in a significant reduction of the incidence of waterborne HAIs. The positive consequences of a comprehensive multibarrier approach including prevention and control programs in health care facilities are discussed. Environmental cultures are now integrated within the infection control program of some European countries. In high-risk areas, the application of disposable sterile point-of-use filters for faucets and shower heads appears to be the practice of choice to efficiently control waterborne pathogens and to prevent infections.

The effect of a polyhexamethylene biguanide mouthrinse compared with a triclosan rinse and a chlorhexidine rinse on bacterial counts and 4-day plaque re-growth

OBJECTIVES

For various clinical applications, polyhexamethylene biguanide hydrochloride (PHMB) has been used for many years as an antiseptic in medicine. Recently, a 0.04% and a 0.12% PHMB mouthwash were shown to inhibit plaque re-growth and to reduce oral bacterial counts. In this study, a 0.2% PHMB mouthrinse (A) was compared with a positive control 0.12% aqueous chlorhexidine solution (B), a commercially available 0.3% triclosan/2.0% polyvinyl methyl ether maleic acid copolymer mouthrinse (Colgate Total Plax) (C), and a negative control placebo rinse (10% ethanol, flavour) (D).

MATERIALS AND METHODS

The controlled clinical study was a double blind, randomized, four replicate cross - over design. Plaque re-growth was assessed with the Turesky et al. (1970) modification of the Quigley & Hein (1962) plaque index. The antibacterial effect was assessed by taking bacterial counts on the tooth surface (smears from the buccal surface of 16/26) and mucosa (smears from the buccal mucosa in opposite of area 16/26) after the professional prophylaxis and after the first rinse with the preparations on day 1 and prior to the clinical examination on day 5. Sixteen volunteers participated and, on day 1 of each study period were rendered plaque-free, ceased toothcleaning, and rinsed twice daily with the allocated mouthrinse. On day 5, plaque was scored and smears were collected according to the protocol. A 10-day wash-out period was carried out between each rinse evaluation. Data were analysed using ancova with Bonferroni HSD adjustment for multiple comparisons (colony forming units per sample) with a significance level alpha=0.05.

RESULTS

The 0.2% PHMB mouthrinse (A) was significantly better at inhibiting plaque than the placebo (D), but significant less effective than the 0.12% aqueous chlorhexidine solution (B). There is no significant difference between A and the 0.3% triclosan/2.0% copolymer mouthrinse (C). Bacterial count reductions (tooth surface and mucosa) with PHMB (A) were significantly greater compared with the placebo (D) and triclosan (C), but significantly lower compared with chlorhexidine (B) (tooth surface) and equally effective compared with chlorhexidine (B) (mucosa).

CONCLUSION

Consistent with previous studies, a PHMB mouthrinse was shown to inhibit plaque re-growth and to reduce oral bacterial counts, indicating that PHMB could be an alternative to established mouthrinses in preventive applications.

Mikrobielle Keratitis nach Laser-in-situ-Keratomileusis

Laser in situ keratomileusis (LASIK) is an effective option and currently one of the most commonly applied surgical techniques in the correction of refractive errors such as myopia, hyperopia, and astigmatism. In contrast to photorefractive keratectomy, it maintains the integrity of Bowman's membrane and the epithelium leading to faster visual rehabilitation as well as less pain and discomfort. Nevertheless, following LASIK the stroma is exposed to infectious organisms. Sight-threatening complications after LASIK are reported to be as rare as 1 in 1000 procedures. However, any infectious keratitis remains potentially devastating. Reports about infectious keratitis following LASIK have increasingly surfaced in recent years. We present a review of the literature on microbial keratitis and present our own cases and recommendations for possible prophylaxis and therapy.

Midterm Results of Routine Bilateral Internal Thoracic Artery Grafting

Background: Skeletonized dissection of the internal thoracic artery (ITA) decreases the occurrence of sternal devascularization, thus decreasing the risk of postoperative sternal complications in patients undergoing bilateral ITA grafting. Methods: From April 1996 to July 1999, 1000 consecutive patients underwent bilateral skeletonized ITA grafting. Of the 770 male and 230 female patients, 420 were older than 70 years, and 312 had diabetes. Results: Operative mortality was 3.3%. Follow-up (4078 months) revealed 79 late deaths, and the Kaplan-Meier 6-year survival rate was 88%. Cox regression analysis revealed increased overall mortality (early and late) in patients with preoperative congestive heart failure (risk ratio [RR], 2.13; 95% confidence interval [CI], 1.31-3.45), in patients with peripheral vascular disease (RR, 5.52; 95% CI, 3.31-9.19), and in patients older than 70 years (RR, 2.18; 95% CI, 1.37-3.47). Early postoperative morbidity included sternal infection (2.2%), cerebrovascular accident (1.6%), and perioperative myocardial infarction (1%). Multiple regression analysis showed repeat operation (odds ratio [OR], 7.5; 95% CI, 1.77-31.6) and chronic obstructive pulmonary disease (OR, 3.6; 95% CI, 1.27-10.75) to be independent predictors of sternal infection. During follow-up, angina returned in 95 patients, 24 of whom required reintervention (20 cases of percutaneous balloon angioplasty and 4 reoperations). Postoperative coronary angiography performed in 87 patients revealed an ITA patency rate of 91%. Conclusions: Bilateral skeletonized ITA grafting is associated with satisfactory early and midterm results. We do not recommend the use of this surgical technique in patients with chronic obstructive pulmonary disease.

Einfluss der Körperkonstitution auf die mittels digitaler Radiogrammetrie evaluierte Knochenmineraldichte

PURPOSE

In addition to many established osteodensitometric techniques, digital radiogrammetry (DXR) is considered to be a reliable method for measuring the cortical bone mineral density (DXR-BMD). This study investigates the influence of body constitution on BMD of healthy adults as calculated by DXR.

MATERIALS AND METHODS

In a prospective study, 246 adults without bone affecting diseases in their clinical history underwent DXR for analysis and calculations of bone mineral density and determination of metacarpal index (MCI) and porosity index (PI). Height, weight and body mass index (BMI) were recorded for each patient.

RESULTS

For all individuals and for all BMI subgroups, both height (0.55 < R < 0.70, p < 0.01) and body weight (0.56 < R < 0.78, p < 0.01) correlated closely with DXR-BMD. Only in the over-weight group, no significant correlation was found between body weight and DXR-BMD. In addition, a significant reduction of the relative DXR-BMD and MCI values was observed between the over-weight and the under-weight group as well as between normal-weight and under-weight individuals (p < 0.01). Otherwise, cortical porosity decreased with increasing body weight.

CONCLUSION

Similar to Dual Energy X-ray Absorptiometry-based studies (DXA), digital radiogrammetry measures an increase in BMD with increasing body weight. Therefore DXR, which provides a precise technique without influence of soft tissue, seems to be a promising technique for quantifying marginal alterations in cortical BMD as well for following the course of osteoporosis.

Digital x-ray radiogrammetry combined with semiautomated analysis of joint space widths as a new diagnostic approach in rheumatoid arthritis: A cross-sectional and longitudinal study

OBJECTIVE

To evaluate digital x-ray radiogrammetry (DXR) and the Radiogrammetry Kit program as new diagnostic tools for quantifying disease-related periarticular osteoporosis and for measuring joint space narrowing according to the severity and duration of rheumatoid arthritis (RA).

METHODS

Using DXR, we performed computerized calculations of bone mineral density (BMD) and the metacarpal index (MCI) in 258 patients with active RA. Using the Radiogrammetry Kit program, we also performed semiautomated measurements of joint space width (JSW) at the second through the fifth metacarpophalangeal (MCP) joints in these patients.

RESULTS

All correlations between the different parameters of both techniques (BMD and the MCI as measured by DXR and MCP JSW as measured by the Radiogrammetry Kit) were significant (0.36 < or = R < or = 0.63; P < 0.01). As expected, a significant negative association was shown between the different MCP JSW results and the results of all scoring methods (-0.67 < or = R < or = -0.29). The BMD and the MCI measured by DXR both decreased significantly between Steinbrocker stage I and stage IV (by 32.7% and 36.6%, respectively; both P < 0.01). Reductions in the overall (mean) MCP JSW varied from 35.3% (Larsen score) to 52.9% (Steinbrocker stage). Over a period of 6 years, we observed relative decreases in BMD and the MCI as measured by DXR (32.1% and 33.3%, respectively), as well as in the overall (mean) MCP JSW (23.5%), and these were pronounced in early RA (duration <1 year). In addition, excellent reproducibility of DXR and Radiogrammetry Kit parameters was verified (coefficients of variation <1%).

CONCLUSION

DXR with the integrated Radiogrammetry Kit program could be a promising, widely available diagnostic tool for supplementing the different RA scoring methods with quantitative data, thus allowing an earlier and improved diagnosis of RA and more precision in determining disease progression.

Influence of the antiseptic agents polyhexanide and octenidine on FL cells and on healing of experimental superficial aseptic wounds in piglets. A double-blind, randomised, stratified, controlled, parallel-group study

The main target of the combination of octenidine with phenoxyethanol (Octenisept) is the antisepsis of acute wounds, whereas polyhexanide combined with polyethylene glycol in Ringer solution (Lavasept) is the agent of choice for antisepsis of chronic wounds and burns. Because comparative data for both agents on the effects on wound healing are lacking, we investigated the influence of preparations based on polyhexanide and octenidine versus placebo (Ringer solution) in experimental superficial aseptic skin wounds (n = 108) of 20 mm diameter, using a double-blind, randomised, stratified, controlled, parallel-group design in piglets. Computerised planimetry and histopathological methods were used for the assessment of wound healing. Histologically, no significant differences could be verified at any time between the 3 groups. However, in the early phase (day 9 after wounding), the octenidine-based product retarded wound contraction to a significantly greater extent than placebo and polyhexanide, whereas in the later phase (days 18 and 28), polyhexanide promoted contraction significantly more than did placebo and octenidine. The consequence is complete wound closure after 22.9 days using polyhexanide, in comparison to the placebo after 24.1 days (p < 0.05) and octenidine after 28.3 days (no statistical difference to placebo). This may be explained by the better tolerance of polyhexanide in vitro, which was demonstrated with dose and time dependence in cytotoxicity tests on human amnion cells.

Polyhexamethylbiguanid (PHMB) zur pr�operativen Antisepsis bei Kataraktoperation

BACKGROUND

We examined the efficacy and tolerability of Lavasept (polyhexamethylenbiguanid or PHMB)-an iodine-free antiseptic-in comparison to polyvinylpyrolidon iodine and Ringer's solution, as an alternative preoperative antiseptic.

PATIENTS AND METHODS

In a randomized controlled double-blind trial 3 drops of Lavasept, 1.25%, PVP-iodine or Ringer's solution were applied preoperatively in 29 patients. The number of colony forming units (cfu) grown from conjunctival smears and conjunctival hyperaemia, corneal epitheliopathy and ocular surface pain were assessed preoperatively, intraoperatively and 1 day postoperatively.

RESULTS

Despite intraoperative application of PVP-iodine, 40% of patients receiving Ringers solution still presented with more than 5 colony forming units (cfu) at the end of the procedure, while all patients that had additional preoperative Lavasept or PVP-iodine achieved relative sterility with less than 5 cfu (p < 0.05). While the effect of Lavasept lasted until the next day, conjunctival microbial colonisation recurred in eyes treated with PVP-iodine. As expected conjunctival hyperaemia and corneal epitheliopathy increased significantly postoperatively but no differences were observed between the 3 solutions tested.

CONCLUSION

The preoperative application of Lavasept reduces the conjunctival flora safely and effectively. The microbicidal efficacy is equal to PVP-iodine, but potentially longer lasting. No signs of local or systemic intolerability were observed. Lavasept may be used as a potential alternative preoperative antiseptic and is suitable for iodine-intolerant patients.