Viscoelastic properties of sterically stabilised emulsions and their stability

The interaction forces between emulsion droplets containing adsorbed polymeric surfactants and the theory of steric stabilisation are briefly described. The results for the viscoelastic properties of O/W emulsions that are stabilised with partially hydrolysed poly(vinyl acetate) that is commonly referred to as poly(vinyl alcohol) (PVA) with 4% vinyl acetate are given. The effect of the oil volume fraction, addition of electrolytes and increasing temperature is described. This allows one to obtain various parameters such as the adsorbed layer thickness, the critical flocculation concentration of electrolyte (CFC) and critical flocculation temperature (CFT) at constant electrolyte concentration. The viscoelastic properties of O/W emulsions stabilised with an A-B-A block copolymer of polyethylene oxide (A) and polypropylene oxide (B) are described. These emulsions behave as viscoelastic liquids showing a cross-over-point between G' (the elastic component of the complex modulus) and G″ (the viscous component of the complex modulus) at a characteristic frequency. Plots of G' and G″ versus oil volume fraction ϕ show the transition from predominantly viscous to predominantly elastic response at a critical volume fraction ϕ(c). The latter can be used to estimate the adsorbed layer thickness of the polymeric surfactants. Results are also shown for W/O emulsions stabilised with an A-B-A block copolymer of polyhydroxystearic acid (PHS, A) and polyethylene oxide (PEO, B). The viscosity volume fraction curves could be fitted to the Dougherty-Krieger equation for hard-spheres. The results could be applied to give an estimate of the adsorbed layer thickness Δ which shows a decrease with increase of the water volume fraction. This is due to the interpenetration and/or compression of the PHS layers on close approach of the water droplets on increasing the water volume fraction. The last section of the review gives an example of O/W emulsion stability using an AB(n) graft copolymer of polyfructose (A) to which several C12 alkyl chains are grafted. The emulsions are stable both at high temperature and in the presence of high electrolyte concentrations (2 mol dm(-3) NaCl). This high stability is due to the strong adsorption ("anchoring") of the graft copolymer with several C12 alkyl chains and the strong hydration of the polyfructose chains both in water and in the presence of high electrolyte concentrations and temperature. Evidence for this high stability is obtained using disjoining pressure measurements which show a highly stable film between the emulsion droplets and absence of its rupture up to high pressures.

Engineering of nano-crystalline drug suspensions: employing a physico-chemistry based stabilizer selection methodology or approach

This paper describes a systematic approach to select optimum stabilizer for the preparation of nano-crystalline suspensions of an active pharmaceutical ingredient (API). The stabilizer can be either a dispersant or a combination of dispersant and wetting agent. The proposed screening method is a quick and efficient way to investigate a large number of stabilizers based on the principles of physical-chemistry and employs a stepwise approach. The methodology has been divided in two main parts; the first part being focused on the qualitative screening with the objective of selecting the best candidate(s) for further investigation, the second part has been focused on quantitative screening with the objective to optimize the ratio and amount of wetting and dispersing agents, based on wettability, surface charges measurement, adsorption evaluation, process-ability evaluation and storage stability. The results showed clearly that SDS/PVP 40/60% (w/w) (sodium dodecyl sulfate/poly(vinyl pyrrolidone)) at a total concentration of 1.2% was the optimum stabilizer composition, at which the resulting nanosuspensions were stable for more than 50 days at room temperature.

Rheological investigations on the creaming of depletion-flocculated emulsions

Preventing creaming or sedimentation by the addition of thickeners is an important industrial challenge. We study the effect of the addition of a "free" nonadsorbing polymer (xanthan gum) on the stability against creaming of sterically stabilized O/W emulsions. Therefore, we analyze our samples using microscopy and rheological measurements. At low xanthan concentrations, the emulsions cream. However, above a certain concentration a three-dimensional network of droplets is formed, which can prevent creaming. We attribute the formation of this structure to depletion attraction. The rheological behavior of an emulsion that is macroscopically stable should be elastic, while it should be viscous for a creaming emulsion. In order to distinguish between stable and unstable samples, we measure their relaxation time by mechanical rheology and find a good correlation to the visual observation. However, the measured relaxation times are much shorter than the time-scales, on which we observe creaming. We hypothesize that the measured relaxation time is related to the droplet-droplet interaction. This determines the frequency at which microscopic rearrangements occur, which weaken the network structure prior to creaming. Based on this interpretation, the relaxation time gives direct access to the microstructural processes involved in creaming. We therefore suggest using it as a predictive parameter of creaming stability.

Primary carnitine deficiency and sudden death: in vivo evidence of myocardial lipid peroxidation and sulfonylation of sarcoendoplasmic reticulum calcium ATPase 2

OBJECTIVES

Primary carnitine deficiency is an autosomal recessive disorder caused by mutations in the SLC22A5 gene which results in impaired carnitine transport, cytosolic fatty acid accumulation and impaired beta oxidation. The disease is associated with cardiomyopathy and arrhythmias, but the mechanism is unknown. We hypothesized that carnitine deficiency results in increased myocardial oxidative stress.

METHODS

We evaluated a 22-year-old woman with primary carnitine deficiency and ventricular fibrillation, as well as her first-degree relatives.

RESULTS

Sequencing of SLC22A5 identified two deleterious mutations (A142S and R488H) and a novel mutation predicted to be a splice variant. Histology demonstrated increased myocardial lipid deposition and swollen mitochondria. Immunohistochemistry demonstrated accumulation of the reactive aldehyde 4-hydroxy-2-nonenal, indicative of increased lipid peroxidation, and sulfonylation of sarcoendoplasmic reticulum calcium ATPase 2 at cysteine 674.

CONCLUSIONS

These findings suggest that increased oxidant stress may contribute to myocardial dysfunction and arrhythmogenesis in this disorder.

Interparticle interactions in concentrated suspensions and their bulk (rheological) properties

The interparticle interactions in concentrated suspensions are described. Four main types of interactions can be distinguished: (i) "Hard-sphere" interactions whereby repulsive and attractive forces are screened. (ii) "Soft" or electrostatic interactions determined by double layer repulsion. (iii) Steric repulsion produced by interaction between adsorbed or grafted surfactant and polymer layers. (iv)and van der Waals attraction mainly due to London dispersion forces. Combination of these interaction energies results in three main energy-distance curves: (i) A DLVO type energy-distance curves produced by combination of double layer repulsion and van der Waals attraction. For a stable suspension the energy-distance curve shows a "barrier" (energy maximum) whose height must exceed 25kT (where k is the Boltzmann constant and T is the absolute temperature). (ii) An energy-distance curve characterized by a shallow attractive minimum at twice the adsorbed layer thickness 2δ and when the interparticle-distance h becomes smaller than 2δ the energy shows a sharp increase with further decrease of h and this is the origin of steric stabilization. (iii) an energy-distance curve characterized by a shallow attractive minimum, an energy maximum of the DLVO type and a sharp increase in energy with further decrease of h due to steric repulsion. This is referred to as electrosteric repulsion. The flocculation of electrostatically and sterically stabilized suspensions is briefly described. A section is devoted to charge neutralization by polyelectrolytes and bridging flocculation by polymers. A distinction could be made between "dilute", "concentrated" and "solid suspensions" in terms of the balance between the Brownian motion and interparticle interaction. The states of suspension on standing are described in terms of interaction forces and the effect of gravity. The bulk properties (rheology) of concentrated suspensions are described starting with the case of very dilute suspensions (the Einstein limit with volume fraction Φ≤0.01), moderately concentrated suspensions (0.2>Φ≥0.1) taking into account the hydrodynamic interaction and concentrated suspensions (Φ>0.2) where semi-empirical theories are available. The rheological behavior of the above four main types of interactions is described starting with "hard-sphere" systems where the relative viscosity-volume fraction relationship could be described. The rheology of electrostatically stabilized suspensions was described with particular reference to the effect of electrolyte that controls the double layer extension. The rheology of sterically stabilized systems is described using model polystyrene suspensions with grafter poly(ethylene oxide) layers. Finally the rheology of flocculated suspensions was described and a distinction could be made between weakly and strongly flocculated systems.

Interaction forces between adsorbed polymer layers

The interaction forces between adsorbed polymer layers were investigated. Two types of graft copolymers that were adsorbed on hydrophobic surfaces have been investigated: (i) a graft copolymer consisting of polymethylmethacrylate/polymethacrylic acid back bone (the B chain) on which several poly(ethylene oxide) chains are grafted (to be referred to as PMMA/PEO(n)); and (ii) a graft copolymer consisting of inulin (linear polyfructose with degree of polymerization >23) (the A chain) on which several C(12) chains are grafted (INUTEC SP1). In the first case adsorbed layers of the graft copolymer were obtained on mica sheets and the interaction forces were measured using the surface force apparatus. In the second case the interaction forces were measured using Atomic Force Microscopy (AFM). For this purpose a hydrophobically modified glass sphere was attached to the tip of the cantilever of the AFM and the glass plate was also made hydrophobic. Both the sphere and the glass plate contained an adsorbed layer of INUTEC SP1. In the surface forces apparatus one essentially measures the energy E(D)-distance D curves for the graft copolymer of PMMA/PEO(n) between mica surfaces bearing the graft copolymer and this could be converted to interaction energy between flat surfaces. Using the de Gennes scaling theory, it is possible to calculate the interaction energy between the polymer layers. The same graft copolymer was used in latex dispersions and the high frequency modulus G'(∝) was measured as a function of the volume fraction Φ of the dispersion. This high frequency modulus could be related to the potential of mean force. In this way one could compare the results obtained from rheology and those obtained from direct measurement of interaction forces. In the AFM method, the interaction forces are measured in the contact area between two surfaces, i.e. a spherical glass particle and a glass plate. Both glass spheres and plates were hydrophobized using dichlorodimethylsilane. Results were obtained for adsorbed layers of INUTEC SP1 in water and in the presence of various concentrations of Na(2)SO(4) (0.3, 0.8, 1.0 and 1.5 mol dm(-3)). All results showed a rapid increase of force with a decrease of separation distance and the forces were still repulsive up to the highest Na(2)SO(4) concentration. This explains the high stability of dispersions when using INUTEC SP1 as stabilizer.

Polymeric surfactants in disperse systems

This overview starts with a section on general classification of polymeric surfactants. Both homopolymers, block and graft copolymers are described. The solution properties of polymeric surfactants is described by using the Flory-Huggins theory. Particular attention is given to the effect of solvency of the medium for the polymer chains. The adsorption and conformation of homopolymers, block and graft copolymers at the solid/liquid interface is described. The theories of polymer adsorption and their predictions are briefly described. This is followed by a description of the experimental techniques that can be applied to study polymeric surfactant adsorption. Examples of adsorption isotherms of non-ionic polymeric surfactants are given. The effect of solvency on the adsorption amount is also described. Results for the adsorbed layer thickness of polymeric surfactants are given with particular attention to the effect of molecular weight. The interaction between particles containing adsorbed layers is described in terms of the unfavorable mixing of the stabilizing chains when these are in good solvent conditions. The entropic, volume restriction or elastic interaction that occurs on considerable overlap is also described. Combination of these two effects forms the basis of the theory of steric stabilization. The energy-distance curve produced with these sterically stabilized systems is described with particular attention of the effect of the ratio of adsorbed layer thickness to droplet radius. Examples of oil-in-water (O/W) and water-in-oil (W/O) emulsions stabilized with polymeric surfactants are given. Of particular interest is the O/W emulsions stabilized using hydrophobically modified inulin (INUTEC((R))SP1). The emulsions produced are highly stable against coalescence both in water and high electrolyte concentrations. This is accounted for by the multipoint attachment of the polymeric surfactant to the oil droplets with several alkyl groups and the strongly hydrated loops and tails of linear polyfructose. Evidence of this high stability was obtained from disjoining pressure measurements. Stabilization of suspensions using INUTEC((R))SP1 was described with particular reference to latexes that were prepared using emulsion polymerization. The high stability of the latexes is attributed to the strong adsorption of the polymeric surfactant on the particle surfaces and the enhanced steric stabilization produced by the strongly hydrated polyfructose loops and tails. Evidence for such high stability was obtained using Atomic Force Microscopy (AFM) measurements. The last part of the overview described the preparation and stabilization of nano-emulsions using INUTEC((R))SP1. In particular the polymeric surfactant was very effective in reducing Ostwald ripening as a result of its strong adsorption and the Gibbs elasticity produced by the polymeric surfactant.

Acinic cell carcinoma-papillary cystic variant. Pitfalls of fine needle aspiration diagnosis: study of five cases and review of literature

OBJECTIVES

Acinic cell carcinoma (ACC) accounts for 12-17% of primary salivary gland carcinomas and 3.4% of all salivary gland neoplasms. ACC-papillary cystic variant (PCV) is a distinct subtype with clear-cut and well-defined morphological features as revealed in tissue sections, but it is more difficult to diagnose accurately on fine needle aspiration (FNA). The aim of this article was to discuss the causes of the erroneous interpretation as well as to draw attention of practicing pathologists to this rare and unique variant of ACC.

METHODS

A computerized search of surgical and cytopathology files identified five diagnoses of ACC-PCV that were preceded by an FNA performed in-house with available slides for review. Cytological features were compared to histomorphological features of excisional surgical pathology specimens.

RESULTS

Cytomorphological findings from these ACC-PCV cases have varied features that can be broadly divided in two major subtypes: hypocellular cystic specimens containing histiocyte-like vacuolated cells (two cases) and more cellular specimens containing papillary clusters of cells with a polymorphous appearance including granular cells, vacuolated cells and nondescript small cuboidal cells (three cases).

CONCLUSIONS

Hypocellular, cyst-like specimens pose a diagnostic problem when using FNA, as they can easily be misinterpreted as a benign cyst of the salivary gland. Our review of cases found certain 'red flags' that should prompt pathologists to further investigate the true acinic origin of hypocellular cystic specimens. On close morphological examination, these specimens revealed the presence of tight cellular clusters, distinct cytoplasmic borders, larger nuclei with distinct nucleoli and binucleated cells.

Interaction forces in thin liquid films stabilized by hydrophobically modified inulin polymeric surfactant. 1. Foam films

Using the interferometric method of Scheludko-Exerowa for investigation of foam films, we have obtained results using a hydrophobically modified inulin polymeric surfactant (INUTEC SP1). Measurements were carried out at constant INUTEC SP1 concentration of 2 x 10(-)(5) mol.dm(-)(3) and at various NaCl concentrations (in the range 1 x 10(-)(4) to 2 mol.dm(-)(3)). At constant capillary pressure of 50 Pa, the film thickness decreased gradually with an increase in NaCl concentration up to 10(-)(2) mol.dm(-)(3) NaCl above which the film thickness remains virtually constant at about 16 nm. This reduction in film thickness with an increase in NaCl concentration is due to the compression of the double layer and at the critical electrolyte concentration (C(el,cr) = 10(-)(2) mol.dm(-)(3)) the electrostatic component of the disjoining pressure is completely screened and the remaining pressure is due to the steric interaction between the adsorbed polymer layers. Disjoining pressure-thickness (Pi-h) isotherms were obtained at C(el) < C(el,cr) (10(-)(4) - 10(-)(3) mol.dm(-)(3)) and C(el) > C(el,cr) (0.5, 1, and 2 mol.dm(-)(3)). In the first case, the disjoining pressure isotherms could be fitted using the classical DLVO theory, Pi = Pi(el) + Pi(vw), and using the constant charge model. At C(el) > C(el,cr), the main repulsion is due to the steric interaction between the polyfructose loops that exist at the air-water interface, i.e., Pi = Pi(st) + Pi(vw). Under these conditions, there is a sharp transition from DLVO to non-DLVO forces. In the latter case, the interaction could be described using the de Gennes' scaling theory. This gave an adsorbed layer thickness of 6.5 nm which is in reasonable agreement with the values obtained at the solid-solution interface. The Pi-h isotherms showed that these foam films are not very stable and they tend to collapse above a critical capillary pressure (of about 1 x 10(3) Pa), and these results could be used to predict the foam stability.

Principles of emulsion stabilization with special reference to polymeric surfactants

This overview summarizes the basic principles of emulsion stabilization with particular reference to polymeric surfactants. The main breakdown processes in emulsions are briefly described. A section is devoted to the structure of polymeric surfactants and their conformation at the interface. Particular attention is given to two polymeric surfactants that are suitable for oil-in-water (O/W) and water-in-oil (W/O) emulsions. For O/W emulsions, a hydrophobically modified inulin (HMI), obtained by grafting several alkyl groups on the backbone of the inulin (polyfructose) chain, is the most suitable. For W/O emulsions, an A-B-A block copolymer of polydroxystearic acid (PHS), the A chains, and polyethylene oxide (PEO), the B chain, is the most suitable. The conformation of both polymeric surfactants at the O/W and W/O interfaces is described. A section is devoted to the interaction between emulsion droplets containing adsorbed polymer surfactant molecules. This interaction is referred to as steric stabilization, and it is a combination of two main effects, namely, unfavorable mixing of the A chains, referred to as the mixing interaction, Gmix, and loss of configurational entropy on significant overlap of the stabilizing chains, referred to as elastic interaction, Gel. The criteria for effective steric stabilization are summarized. O/W emulsions based on HMI are described, and their stability in water and in aqueous electrolyte solutions is investigated using optical microscopy. Very stable emulsions can be produced both at room temperature and at 50 degrees C. The reason for this high stability is described in terms of the multipoint anchoring of the polymeric surfactant (by several alkyl groups), the strong hydration of the inulin (polyfructose) chains, and the high concentration of inulin in the adsorbed layer. W/O emulsions using PHS-PEO-PHS block copolymer can be prepared at a high volume fraction of water, varphi, and these emulsions remain fluid up to high varphi values (> 0.6). These emulsions also remain stable for several months at room temperature and at 50 degrees C. The last two sections are concerned with the problems of creaming or sedimentation and phase inversion. Creaming or sedimentation can be prevented by the use of "thickeners" in the continuous phase. These molecules produce non-Newtonian systems that will have a high residual or zero shear viscosity. The latter, which may exceed 1000 Pas, can also be prevented by control of the bulk (or elastic) modulus of the system. Phase inversion in O/W emulsions can also be prevented using HMI, since this polymeric surfactant is not soluble in the oil phase. As long as coalescence and Ostwald ripening are prevented, the emulsions can remain stable for very long times both at room temperature and at 50 degrees C.

Formation and stability of nano-emulsions

This review describes the principles of formation and stability of nano-emulsions. It starts with an introduction highlighting the main advantages of nano-emulsions over macroemulsions for personal care and cosmetic formulations. It also describes the main problems with lack of progress on nano-emulsions. The second section deals with the mechanism of emulsification and the dynamic light scattering technique for measurement of the droplet size of nano-emulsions. This is followed by a section on methods of emulsification and the role of surfactants. Three methods are described for nano-emulsion preparation, namely high energy emulsification (using homogenisers), low energy emulsification whereby water is added to an oil solution of the surfactant and the principle of the phase inversion temperature (PIT). A section is devoted to steric stabilisation and the role of the adsorbed layer thickness. The problem of Ostwald ripening (which is the main instability process of nano-emulsions) is described in some detail. The methods that can be applied to reduce Ostwald ripening are briefly described. This involves the addition of a second less soluble oil phase such as squalene and/or addition of a strongly adsorbed and water insoluble polymeric surfactant. The last part of the review gives some examples of nano-emulsions that are prepared by the PIT method as well as using high pressure homogeniser. A comparison of the two methods is given and the rate of Ostwald ripening is measured in both cases. The effect of changing the alkyl chain length and branching of the oil was investigated using decane, dodecane, tertadecane, hexadecane and isohexadecane. The branched oil isohexadcecane showed higher Ostwald ripening rate when compared with a linear chain oil with the same carbon number.

Application of rheology for assessment and prediction of the long-term physical stability of emulsions

This review deals with the use of rheology for assessment and prediction of the long-term physical stability of emulsions. It starts with an introduction, highlighting the importance of having accelerated test to predict emulsion stability. This is followed by a section on the stability/instability of emulsion systems, giving a brief summary of the driving force of each instability process and its prevention. The classical techniques that can be applied for assessment of creaming or sedimentation, flocculation, Ostwald ripening, coalescence and phase inversion are briefly described. This is followed by several sections on the application of rheological techniques to assess and predict each of these instabilities. This involves the use of steady state shear stress-shear rate measurements, constant stress (creep) measurements and dynamic (oscillatory) techniques. The last section gives an example of model emulsions to illustrate the correlation between the various break-down processes with the rheological characteristics of the system.

Interaction forces between particles containing grafted or adsorbed polymer layers

The interaction forces between particles containing grafted or adsorbed polymer layers have been investigated using rheological and surface force measurements. Polystyrene latex dispersions with grafted poly(ethylene oxide) (PEO) chains (M=2000) were used for the rheological measurements. Results were also obtained for latex dispersions stabilised with adsorbed graft copolymers of poly(methyl methacrylate-methacrylic acid) with methoxy capped PEO chains (M=750). The relative viscosity eta(r)-volume fraction phi curves for the latex dispersions with grafted PEO chains were established for three particle radii of 77.5, 306 and 502 nm. For comparison the eta(r)-phi curve was calculated using the Dougherty-Krieger equation. This allows one to obtain the adsorbed layer thickness delta as a function of phi. The results showed a decrease of delta with increase of phi, which was attributed to the interpenetration and/or compression of the PEO chains on increasing phi. Viscoelastic measurements as a function of phi showed a change from predominantly viscous to predominantly elastic response at a critical volume fraction, which indicated the onset of the strong steric repulsion when the polymer layers begin to overlap. A similar trend was obtained with the latex particles containing adsorbed graft copolymer layers. A scaling law was used to fit the elastic part of the logG'-log phi curve (where G' is the elastic modulus). This fit could be used to estimate the compressibility of the PEO chains. The correlation of the rheology of concentrated sterically stabilised dispersions with interparticle interactions was investigated by measuring the energy-distance curves for the graft copolymer that was adsorbed on smooth mica sheets. Using de Gennes scaling theory, it was possible to calculate the energy of interaction between the polymer layers. The high frequency modulus of the latex dispersions was obtained as a function of the volume fraction and the results were compared with those calculated from the potential of the mean force. The trends in the variation of the modulus with volume fraction were similar for the experimental rheological results and those calculated using the directly measured interaction forces. The above results demonstrated the powerful use of rheological measurements for studying the interaction between sterically stabilised dispersions in concentrated systems.

Cervical schistosomiasis, human papilloma virus (HPV), and human immunodeficiency virus (HIV): a dangerous coexistence or coincidence?

BACKGROUND

Female genitourinary schistosomiasis (FGS) is widespread in endemic areas causing significant morbidity and mortality. Recent data suggest that FGS of the cervix not only is considered a risk factor for contracting different sexually transmitted diseases (STD), but also plays a significant role in modifying the natural history and immunological response to those infections, in particular HIV and HPV.

CASE REPORT

A 32-year-old female from Zambia, who was recently diagnosed with HIV and high-grade dysplasia with koilocytosis on cervical Pap smear, underwent cervical conization which confirmed moderate cervical dysplasia and also revealed the presence of viable and nonviable schistosoma eggs in cervical stroma. Four different HPV types were isolated by PCR, including one "low-risk" (type 6) and three "high-risk" types (types 45,56, and 58).

CONCLUSION

The presence of HPV, HIV infection, and cervical schistosomiasis in our patient is likely more than coexistence of multiple agents in the same milieu as cervical schistosomiasis increase susceptibility for other STDs including HIV and HPV. Therefore, in patients with schistosomiasis, immediate treatment for schistosomiasis and additional testing for HIV and HPV is warranted.

Hepatic blood flow and oxygen consumption after burn and sepsis

BACKGROUND

Alteration in the hepatic circulation after burn and in sepsis seems to be an essential component in the development of multiple organ failure.

METHODS

Female pigs (n = 12, 20-25 kg) were instrumented with ultrasonic flow probes on the portal vein and the common hepatic artery. Catheters were inserted in the superior mesenteric and left hepatic veins. After 5 days, all animals were anesthetized and six of them received 40% total body surface area third-degree burn. A total of 100 microg/kg Escherichia coli LPS was intravenously administered at 18 hours after burn. All animals were studied for 42 hours.

RESULTS

Thermal injury resulted in a 48% decrease in hepatic arterial blood flow despite maintenance of normal cardiac output, resulting in a fall in hepatic oxygen delivery rate. Portal venous blood flow showed a 32% increase at 4 hours after burn. Post-LPS portal blood flow was significantly reduced for a period of 8 hours (51% of baseline (bl), p < 0.05 analysis of variance [ANOVA]). The hepatic arterial blood supply was also significantly reduced (12-67% of bl, p < 0.05 ANOVA) during the first 4 hours after LPS, indicating loss of the hepatic arterial response. The following 12 hours, a hepatic reperfusion phase was observed with an elevation of the hepatic arterial blood flow to 152% of bl (p < 0.05 ANOVA). Postburn endotoxemia resulted in a significant decrease of hepatic oxygen delivery (88%) and hepatic oxygen consumption (79%). Although the burn injury did not affect the portal venous pressure, postburn endotoxemia caused a significant portal hypertension during a period of 8 hours (225% of bl, p < 0.05 ANOVA).

CONCLUSION

Postburn sepsis amplifies the selective vasconstrictive impact of thermal injury on hepatic arterial blood flow, yielding a pronounced ischemia/ reperfusion injury, associated with a critical reduction of hepatic oxygen delivery and consumption. A postburn septic challenge induces portal hypertension, which may account for previously documented gut barrier dysfunction.

Trauma- and sepsis-induced hepatic ischemia and reperfusion injury: role of angiotensin II

HYPOTHESIS

We hypothesized that angiotensin II, a potent vasoconstrictor, is involved in the occurrence of hepatic ischemia after burn and sepsis, and that administration of angiotensin II antagonist DuP753 would ameliorate this process.

DESIGN

Randomized animal study.

SETTING

University laboratory, investigational intensive care unit, University of Texas Medical Branch, Galveston.

MATERIALS

Female pigs (n = 18, weighing 20-25 kg).

INTERVENTIONS

All animals were prepared with ultrasonic flow probes on the portal vein and the common hepatic artery. Catheters were inserted in the superior mesenteric and left hepatic veins. After 5 days all animals were anesthetized and 12 of them received 40% total body surface area third-degree burn. Escherichia coli lipopolysaccharide (100 microg/kg) was intravenously administered at 18 hours postburn DuP753 was administered intravenously in a dose of 1 microg/kg to 6 pigs immediately after the burn. All animals were studied for 42 hours.

MAIN OUTCOME MEASURES

Systemic and hepatic hemodynamics were measured and blood samples were drawn for determinations of arterial, mixed venous, and portal blood gases at baseline and at 14 consecutive time points, starting 1 hour after the burn.

RESULTS

Burn caused a 4.6-fold increase in hepatic arterial vascular resistance and a 49% decrease in hepatic arterial blood flow. Postburn administration of angiotensin II receptor blocker DuP753 yielded a significant improvement in the hepatic arterial hemodynamics (only 12% increase in hepatic arterial vascular resistance and 8% decrease in hepatic arterial blood flow, P<.05 vs nontreated group, analysis of variance [ANOVA]). Postlipopolysaccharide hepatic arterial blood flow was significantly reduced (12% of baseline, P<.05, ANOVA), in contrast to DuP753-treated animals (64% of baseline, P<.05 vs nontreated group, ANOVA). Postburn blocking of angiotensin II receptors yielded a significant improvement in postlipopolysaccharide portal venous blood flow (85% of baseline vs 48% of baseline in nontreated animals, P<.05, ANOVA ). Postburn endotoxemia resulted in a significant decrease of hepatic oxygen delivery (22% of baseline) and hepatic oxygen consumption (30% of baseline), while no marked changes were observed in the DuP753-treated group (P<.05 vs nontreated group, ANOVA).

CONCLUSIONS

Angiotensin II seems to play a pivotal role in burn- and sepsis-induced hepatic ischemia and reperfusion injury. Blocking angiotensin II receptors by DuP753 seems to abrogate this adverse effect of thermal injuries and sepsis on hepatic perfusion and oxygenation.

Angiotensin II inhibitor DuP753 attenuates burn- and endotoxin-induced gut ischemia, lipid peroxidation, mucosal permeability, and bacterial translocation

OBJECTIVE

To investigate the role of angiotensin II as a mediator of burn- and sepsis-induced gut ischemia and reperfusion injury and to determine whether treatment with the angiotensin II inhibitor DuP753 can attenuate mucosal injury and bacterial translocation in a burn/endotoxemia porcine model.

SUMMARY BACKGROUND DATA

Thermal injuries and endotoxemia have been shown to induce ischemia and reperfusion injury to the intestine, leading to increased mucosal permeability and bacterial translocation. Angiotensin II, the production of which has been reported to increase after burn, is thought to be one of the primary mediators of postburn mesenteric vasoconstriction.

METHODS

An ultrasonic flow probe was inserted into the superior mesenteric artery and a catheter into the superior mesenteric vein in 21 female pigs. After 5 days, all animals were anesthetized, and 14 received 40% total body surface area third-degree burn. DuP753 was administered intravenously at 1 microg/kg to seven pigs immediately after burn. Eighteen hours after burn, 100 microg/kg Escherichia coli lipopolysaccharide (LPS) was intravenously administered. Systemic and splanchnic hemodynamics were measured and blood samples were drawn for blood gas analysis. Plasma conjugated dienes (PCDs), an index of lipid peroxidation, were measured every 6 hours. Intestinal permeability was assessed every 6 hours by measuring the lactulose/mannitol excretion ratio. At the end of the study (42 hours), tissue samples were harvested for bacteriologic cultures.

RESULTS

Burn caused a significant decrease in mesenteric blood flow, to approximately 58% of baseline. Postburn endotoxemia significantly reduced the blood flow in the superior mesenteric artery to 53% of baseline. Treatment with DuP753 prevented postburn vasoconstriction and subsequently abrogated the impact of postburn endotoxemia on blood flow in the superior mesenteric artery. Mesenteric oxygen supply was significantly reduced after burn and endotoxin to 60% and 51% of baseline levels, respectively. DuP753 administration significantly improved mesenteric oxygen supply after both insults. Burn- and LPS-induced mesenteric hypoxia, as indicated by decreased mesenteric oxygen consumption, was also ameliorated by DuP753 treatment. PCD levels were significantly elevated 8 hours after burn. LPS caused a higher and prolonged increase in PCD levels. Treatment with DuP753 significantly reduced PCD levels after burn and after LPS. Intestinal permeability, as assessed by the lactulose/mannitol ratio, showed 6-fold and 12-fold increases after thermal injury and LPS, respectively. In contrast, the lactulose/mannitol ratio was only doubled in DuP753-treated animals. Bacterial translocation was significantly increased after burn and endotoxin. The incidence of bacterial translocation in the DuP753-treated animals was similar to that in the sham group.

CONCLUSIONS

Angiotensin II appears to play a pivotal role in the burn- and endotoxin-induced intestinal ischemia and reperfusion injury, with subsequent increases in permeability and bacterial translocation. Postburn administration of the angiotensin II receptor antagonist DuP753 significantly reduces the extent of these events.

Opposite effects of interleukin-2 on normal and transfusion-suppressed healing of experimental intestinal anastomoses

OBJECTIVE

This study was done to investigate whether administration of interleukin-2 (IL-2) can abrogate the negative effects of blood transfusions on anastomotic healing.

SUMMARY BACKGROUND DATA

Recently, the authors showed that blood transfusion severely impairs anastomotic repair and significantly increases the susceptibility to intra-abdominal septic complications in rats. It has been reported that blood transfusions suppress IL-2 production and that IL-2 may stimulate wound healing.

METHODS

Lewis rats underwent resection and anastomosis of both the ileum and colon. Subsequently, they received either 3 mL of saline (control and IL-2 groups) or 3 mL of blood from brown Norway donors (transfusion and transfusion/IL-2 groups) intravenously. From the operation onward, the animals in the IL-2 and transfusion/IL-2 groups received daily injections of 5.4 x 10(5) IU of IL-2 in dextrose solution subcutaneously; the rats in the other groups received only the dextrose solution. The animals were killed 3 or 7 days after the operation and examined for septic complications and anastomotic repair.

RESULTS

Transfusion led to an enhanced incidence of anastomotic abscesses, which was almost completely abrogated after IL-2 administration. The anastomotic strength was consistently and significantly reduced after transfusion. Seven days after surgery, the anastomotic strength was completely restored by IL-2 treatment. For instance, the average bursting pressure (+/- the standard deviation) of the ileal anastomoses in the control, transfusion, and transfusion/IL-2 groups were 86 +/- 15, 32 +/- 8,* and 63 +/- 10 mmHg* [symbol: see text] on day 3 and 293 +/- 36, 227 +/- 16,* and 299 +/- 19 mmHg on day 7, respectively (where * = significant vs. control group and [symbol: see text] = significant vs. transfusion group). In addition, IL-2 administration elevated the anastomotic hydroxyproline content, which was significantly decreased by transfusion alone, to the level found in the control group. The administration of IL-2 to control animals resulted unexpectedly in a significant reduction in anastomotic strength.

CONCLUSIONS

Exogenous IL-2 reverses the negative effects of blood transfusions on anastomotic repair, but it impairs healing under normal conditions.

Breast fine needle aspiration cytology. Utility as a screening tool for clinically palpable lesions

We examined breast fine needle aspiration cytology's role as a screening tool in addition to mammography and clinical examination for palpable breast lesions, circumventing operative biopsy of benign lesions while identifying cancer for definitive treatment and significant ductal proliferations that need histologic evaluation, such as atypical ductal hyperplasia and marked ductal hyperplasia. Five hundred thirty-three consecutive palpable breast lesions in 498 patients referred to cytopathologists were aspirated and the cytologic findings reported as follows: (1) malignant, treat as any histologic diagnosis of breast cancer (85); (2) suspicious, intraoperative or biopsy confirmation before therapy (11); (3) atypical, biopsy recommended to exclude breast cancer or significant ductal proliferation (atypical ductal hyperplasia and marked ductal hyperplasia) (45); (4) benign, excision not necessary (334); and (5) nondiagnostic, no ductal cells, and biopsy recommended if indicated clinically (58). Excision of 57/85 malignant lesions confirmed cancer in all cases. Follow-up of the remaining 28 patients showed: 17 were undergoing treatment for cancer without surgery, 8 were dead of the disease, and 3 were lost to follow-up. Biopsy of 11/11 suspicious lesions confirmed cancer. Biopsy of 27/45 atypical lesions showed: 1 carcinoma, 12 significant ductal proliferations (1 atypical ductal hyperplasia and 11 marked ductal hyperplasia) and 14 benign, nonproliferative breasts; 18 atypical lesions from 14 patients were not biopsied. Biopsy of 61/334 benign lesions showed 51 benign nonproliferative breasts, 7 missed significant ductal proliferations (6 marked ductal hyperplasia and 1 atypical ductal hyperplasia) and 3 false negatives (3 carcinomas). The three false negatives and the atypical ductal hyperplasia had a biopsy because of an abnormal mammogram. Review of material from false-negative cases showed underinterpretation of cells present on cytology slides in two cases and carcinoma missed by the aspiration needle in one case. The atypical ductal hyperplasia was in a separate, nonpalpable area in the same breast. Biopsy was avoided in 273/334 benign lesions from 249 patients: 86 had no follow-up, 160 had stable lesions, and 3 reported a change in their lesions (mean follow-up, 13 months). One of these three had a biopsy that showed a benign, nonproliferative breast. Biopsy of 11/58 nondiagnostic lesions showed 9 benign nonproliferative breasts, 1 atypical ductal hyperplasia and 1 carcinoma. No biopsy was performed on 47/58 nondiagnostic lesions from 45 patients: 1 had a repeat aspiration that was malignant, 10 had no follow-up, 33 had stable lesions, and 1 had an increase in the size of her lesion (mean follow-up, 13 months).(ABSTRACT TRUNCATED AT 400 WORDS)

Blood transfusion impairs the healing of experimental intestinal anastomoses

Blood transfusions are reported to impair the cell-mediated immune response. Because both T lymphocyte and macrophage function are important for wound repair, the authors investigated the effect of blood transfusions on anastomotic repair. Lewis rats underwent resection of both ileum and colon, followed by the construction of either an everted or an inverted end-to-end anastomosis. Immediately after operation, they received either 3 mL saline intravenously, or 3 mL heparinized blood from Lewis or Brown Norway donors. The animals were killed 3 or 7 days after operation, and anastomotic strength was assessed by measuring the bursting pressure. Anastomotic abscesses and generalized peritonitis were not found in the control group. Blood transfusions, particularly allogeneic, significantly increased the incidence of these septic complications. Three days after operation, anastomotic strength was significantly reduced in both Lewis and Brown Norway transfused groups. For instance, average bursting pressures (+/- standard deviation [SD]) of inverted ileal anastomoses were 79 +/- 13 mmHg in the control group and 46 +/- 14 and 21 +/- 12 mmHg in the Lewis and Brown Norway transfused groups, respectively. Seven days after operation, the rupture site was found significantly more often within the anastomotic line in the animals that had received blood transfusions. The authors conclude that blood transfusions impair the healing of experimental intestinal anastomoses and increase susceptibility to intra-abdominal sepsis.

Vaginocervical cytology in victims of sexual assault

To investigate the role of vaginocervical smears in alleged victims of rape, we reviewed the findings in 4,220 consecutive rape victims between the years 1982 and 1989. These rape victims showed a slight increase in cellular abnormalities (1.18% vs. .93%) when compared to a group of 17,187 routine smears from an indigent population in 1989. While the differences in the spectrum of cellular abnormalities were not statistically significant, the increase in abnormal smears is remarkable because of the younger age distribution and lower risk factors for cervical cancer in this group of rape victims (41% of the victims were never seen at our institution before their evaluation for alleged rape and were most probably of higher socioeconomic status and at lower risk for cervical cancer than the indigent population served at our hospital). This finding may reflect the low incidence of vaginocervical cytology screening among the general population of which rape victims are a random sample. Fifty-seven percent of the rape victims with cellular abnormalities who were also regular patients at our hospital returned for follow-up by appropriate repeat smears or biopsies. This was lower than the 95% general follow-up rate of vaginocervical smear abnormalities among the rest of the population screened at our hospital. We detected spermatozoa in 56% of the smears from victims who were examined within three days of the alleged sexual assault. Cytology adds to the criminal investigation of rape cases as we detected spermatozoa in four of 16 semen-negative cases from a random sample of 53 cases evaluated by the state crime lab.

Studies of major histocompatibility complex class I/II expression on sequential human heart biopsy specimens after transplantation

Our previous data indicate that normal human cardiac myocytes do not express detectable levels of major histocompatibility complex (MHC) class II gene products and express only low levels of MHC class I gene products. Examination of heart biopsy samples after transplantation with immunoperoxidase techniques revealed that such myocytes are induced to express high levels of MHC class I/II gene products and that the expression of these gene products appeared to precede histologic evidence of rejection. In efforts to objectively quantitate the level of MHC antigen expression on sequential heart biopsy samples, a radioimmunoassay was set up. Monoclonal antisera was used against human monomorphic MHC class I and II determinants. In addition, to control for the variability in the quantity of biopsy sample, use was made of a monoclonal antisera against human cardiac myosin. A series of three to four sections (4 micron each) of the heart biopsy specimen was treated with each antisera, followed by affinity purified and absorbed iodine 125-labeled goat antimouse immunoglobulin. The mean counts per minute of MHC class I and II was divided by the mean counts per minute obtained with anti-myosin and an index of MHC class I/II derived. Data using such a radioimmunoassay indicate that MHC antigen expression on the heart biopsy specimens does not strictly correlate with histologic rejection grade scores, levels of leukocyte infiltrate, or the immunophenotype of the infiltrating mononuclear cells. Of interest was the finding that an increase in the level of MHC antigen expression occurred before histologic evidence of rejection grades of 3 or greater. In addition, MHC class I antigen expression appeared to increase in heart biopsy samples early during the post-transplant period, followed sequentially by an increase in the level of MHC class II antigen expression. Rejection episodes later during the posttransplant period, however, were accompanied by increased levels of MHC class II antigens. A kinetic analysis of the increase in the levels of MHC class I and II antigens on heart biopsy samples may not only provide a refinement of the histologic scoring of heart biopsy samples for rejection but may also suggest the use of different chemotherapeutic immunosuppressive drug regimens for the treatment of MHC class I as compared with MHC class II dependent rejection episodes.