8-Styryl-substituted coralyne derivatives as DNA binding fluorescent probes

8-Styryl-substituted coralyne derivatives bind to duplex and quadruplex DNA and may be used for fluorimetric staining of nucleoli in cells.

Six new 8-styryl-substituted coralyne derivatives 4a–f were synthesized from coralyne (2) by a base catalysed Knoevenagel type reaction. It was shown by photometric and fluorimetric titrations of double stranded and quadruplex DNA to 4b–d as well as by fluorimetric DNA denaturation experiments that these ligands bind to DNA with different binding modes at varying ligand-DNA ratios (LDR). Specifically, the addition of DNA caused initially a hypochromic effect in absorbance and, at a particular LDR, the development of a new red shifted absorption band with a hyperchromic effect. Furthermore, 4b–d induced a significant and selective stabilization of quadruplex DNA towards unfolding (ΔT_m = 31.6–32.9 °C at LDR = 5), which is even more pronounced as compared to the parent compound coralyne (2). Most notably, the addition of DNA to the dimethylamino-substituted derivative 4b leads to a new, strongly red-shifted emission band at 695 nm. Hence, this derivative is a fluorescent probe that changes its fluorescence colour from green to red in the presence of DNA and even allows the fluorimetric analysis of living cells by staining of the nucleoli.

Effects of Vaginal Estrogens on Serum Estradiol Levels in Postmenopausal Breast Cancer Survivors Taking an Aromatase Inhibitor or a Selective Estrogen Receptor Modulator

Introduction: Intravaginal estradiol (E2) has been proposed as a safe alternative to systemic estrogen therapy. We report serum E2 levels in breast cancer survivors using either vaginal E2 ring (Estring®) or beta E2 tablet (Vagifem®) while also taking an aromatase inhibitor (AI) or selective estrogen receptor modulator (SERM). These patients are compared to a group of breast cancer survivors using an AI but not taking a VE. Patients and Methods: Postmenopausal women with estrogen receptor positive breast cancer (n=24) using an AI or SERM and vaginal estrogens (VE) to control atrophic vaginitis (ring inserted every 90 days; n=10 or 1 tablet inserted 2 x per week; n=14) and 24 control survivors using an AI without VE were enrolled after informed consent. Serum samples were drawn from ring patients pre-insertion and 30 and 60 days post insertion, from tablet patients the morning prior to insertion and 12 hours post insertion, and from controls taking an AI >14 d. Serum samples were assayed for E2 concentrations by highly sensitive radio-immunoassay (Cancer Res 1987;47:1957). Statistical analyses were carried out using SAS® System, v. 9.2. Results: Patient data are provided in tables 1 and 2 (control data not shown). Circulating E2 levels pre-insertion in tablet patients were not significantly different than those in control patients (mean difference=4.7 pmol/l SD:3.2; CI: 2.9-4.9, p=0.48). E2 levels pre-insertion in patients using the ring were significantly greater than controls (mean difference=14.2 pmol/l; SD:7.2;CI, 11-19:p=0.0001). In tablet patients, E2 levels at 12 hours post insertion were 76 pmol/l higher than at pre-insertion baseline (SD:97; CI, 14-89, p<0.0001), and E2 levels at 12 weeks post insertion in ring patients were 30 pmol/l higher than at pre-insertion baseline(SD:50; CI: 10-20, p=0.001). Discussion: Our data did not show a significant difference in pre-insertion E2 levels for the tablet compared to controls, but we did observe a significant difference in pre-insertion E2 levels for the ring compared to controls. Importantly, we also observed a significant elevation in E2 levels in most patients using VEs post insertion, regardless of the type of device (tablet or ring). The clinical significance of vaginal E2 absorption is unknown, although elevated E2 levels are diametrically opposite of the desired effect for breast cancer patients taking an AI. Vaginal estrogen in patients receiving an adjuvant AI must be advised with caution.ID#SERM/AIPRE-INSERTION PMOL/LPOST-INSERTION PMOL/LMONTHS ON TABLETV4T4.61424V10T35.449V13TIS193V14T1330813V2L4.91912V9L<3.01938V11L<3.01318V5E105773V1A<3.01912V3A<3.0<3.014V6A<3.08918V7A<3.03348V8A5.322936V12A<3.06113IS=Insufficient sample; A=anastrozole; L=letrozole; E=exemestane; T=tamoxifen; R=raloxifeneTable 2. Cases on VE E2 Ring and AI or SERMID #SERM/AIPRE-INSERTION PMOL/L30 DAYS PMOL/L60 DAYS PMOL/LMONTHS ON RINGE6T25222015E9T11169.815E10T15201712E8R18151412E4L19161512E5L<3.0<3.0<3.09E7L<3.0<3.0<3.054E1A121071693E2A1511116E3A2131356 

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 806.

Reduced Liver Apoptosis After Venous Systemic Oxygen Persufflation in Non-Heart-Beating Donors

Graft injury caused by warm ischemia in livers from non-heart-beating donors (NHBDs) strongly affects posttransplantation outcome and is associated with liver apoptosis, which is mediated by death receptors, such as Fas, a surface receptor of the tumor necrosis factor (TNF)-alpha family. The aim of this study was to test the ability of venous systemic oxygen persufflation (VSOP) to reduce apoptotic changes and Fas activation in the liver after warm ischemic insult in vivo. Livers of male Wistar rats were harvested 30 min after cardiac arrest from non-heart-beating donors (NHBD) with (NHBD + O2) or without (NHBD) application of gaseous oxygen during the cold storage period via the suprahepatic caval vein. After 24 h of storage in University of Wisconsin solution at 4 degrees C, viability of the livers was assessed upon isolated reperfusion in vitro. Conventional signs of tissue damage like enzyme release and bile production showed a significantly elevated nonspecific cell injury in the NHBD group. TUNEL staining revealed increased DNA fragmentation of sinusoidal endothelial cells in the NHBD group and more apoptotic hepatocytes than in the control group. All these alterations could be almost abrogated by the use of VSOP in the NHBD + O2 group. The immunohistochemical staining of Fas antigen expression showed a significantly elevated Fas receptor expression in the NHBD and NHBD + O2 groups, in accord with an eightfold increase of Fas receptor mRNA detected by real-time reverse-transcription polymerase chain reaction (RT-PCR). These results demonstrate that the postischemic apoptotic rate of sinusoidal endothelial cells in NHBD livers can be reduced by the use of VSOP. A significant improvement in liver integrity and viability was obtained with this technique, without influencing the expression of Fas expression.

Oxidation of citronellal to citronellic acid by molecular oxygen using supported gold catalysts

The oxidation of citronellal to citronellic acid was studied using molecular oxygen as oxidant and gold-containing supported catalysts under aqueous conditions. The reactions were carried out at 60-90 degrees C, with 200 Nml min(-1) O2 and at pH values from 9 to 12. The alumina- or titania-supported catalysts were synthesized according to the deposition-precipitation procedure using urea or NaOH. Mechanistic studies have revealed that radical-initiated reactions lead to undesired by-products especially at pH <9, that is, the C=C bond is attacked and a diol is primarily formed probably via an epoxide intermediate. This side reaction can be suppressed to a large extent by increasing the pH to 12 and by raising the catalyst/oxygen ratio. Furthermore, detailed studies on the influence of reaction time, pH value, reactant concentration and amount of catalyst show that citronellic acid can be obtained in over 90% yield with total conversion of citronellal at pH 12 and a temperature of 80 degrees C.

[Port stapling for simplified port implantation in laparoscopic adjustable gastric banding]

BACKGROUND

The purpose of this study was to evaluate the applicability of a port stapling device to simplify and improve port implantation in laparoscopic adjustable gastric banding (LAGB).

METHODS

From November 2005 to September 2006, a prospective study was conducted on 23 consecutive patients who underwent LAGB with Swedish adjustable gastric banding. Patients were randomized to either conventional titanium-port implantation or port stapling using the "Velocity" device.

RESULTS

No differences in age, body weight, body mass index, fascia depth or incision length were reported between the groups. Port implantation time was significantly less using port stapling (90+/-24 s) compared to conventional port implantation (521+/-138 s). Port related complaints postoperatively and at follow-up were equal in both groups.

CONCLUSIONS

Port stapling is an excellent tool to facilitate port implantation, particularly in massively obese patients with a thick abdominal wall.

The pre-treatment PET scans SUV inversely correlates with overall survival (OS) of high grade NHL

17543

Background: Parling-Lynch (Blood 2003; Abs, 102(11):4805). report a high discriminative power of maximum standard uptake value (SUV) in differentiating high and low grade lymphoma. This study examines the relationship between the pre-treatment (18)F-2-deoxy-2-fluoro-D-glucose Positron emission tomography (18-FDG PET) scans, SUV, overall survival (OS) and disease free survival (DFS) in high grade non-Hodgkin’s lymphoma (NHL). Methods: 33 patients with pathological diagnosis of aggressive NHL but without other malignancies were included; the patients had a pre treatment 18-FDG PET scan with calculated SUV. NHL was classified using WHO classification, IPI score was calculated using International Non-Hodgkin’s Lymphoma Prognostic Factors Project criteria. Cox Proportional Hazards Regression analysis was used to assess the effect of SUV and the grouped IPI Score on both overall survival and disease-free survival. Results: 29 patients have diffuse large B-cell lymphoma (DLBCL), 2 have Mantle cell lymphoma (MCL) and 2 have peripheral T-cell lymphoma (PTCL). Over a median follow up of 2.6 years (0.6–4.6), OS and DFS were 76% and 82%, respectively. Median SUV was 18.6 (1.6–55.9). Patients with higher SUV have higher risks of dying after adjusting for their IPI Score (p-value = 0.0038). Specifically, each additional unit of SUV is associated with a 9.8% increase in the hazard of death. Patients with higher IPI Score have higher risks of dying after adjusting for their SUV (p-value = 0.0017). Specifically, each additional level of IPI Score is associated with a 274.9% increase in the hazard of death. SUV is not a significant predictor of disease-free survival once IPI Score is already known/adjusted for (p-value = 0.0731). Patients with higher IPI Score have higher risks of relapse after adjusting for their SUV (p-value = 0.023). Conclusions: Pre-treatment PET scan SUV significantly affects overall survival in high grade NHL. Our data indicate statistically non significant correlation between SUV and DFS. These findings could be secondary to small study sample or short median follow up.

No significant financial relationships to disclose.

Terminal ileitis with sealed perforation?a rare complication of intestinal endometriosis: case report and short review of the literature

INTRODUCTION

Perforation is a rare complication of intestinal endometriosis. We report on a 38-year-old patient with previously known rectovaginal and ileocecal endometriosis who was referred with an acute abdomen.

CASE REPORT

On abdominal plain film an ileus of small intestine was diagnosed. The patient had fever, and the C-reactive protein was markedly increased. Upon emergency laparotomy an acute terminal ileitis with omentum-sealed perforation and a stenosis of the anterior wall of the rectum due to endometriosis were found. Partial resection of the ileum with end-to-end anastomosis, appendectomy, and short segmental rectum resection were performed. The postoperative course was uneventful. Histological examination corroborated the intraoperative diagnosis of fistulas, perforation and deep ulceration of the intestine consistent with transmural endometriosis.

DISCUSSION

For proper care of these patients excellent cooperation between gynecologists and general surgeons is desirable. A short review of the literature concerning intestinal endometriosis is given.

Quantitation of human immunodeficiency virus type 1 in breast milk

The distribution and stability of human immunodeficiency virus type 1 (HIV-1) in breast milk (BM) components remain largely unknown. Inhibitory effects, if any, of BM on HIV RNA and DNA PCR amplification are poorly understood. We have addressed these issues by using virus-spiked BM samples from HIV-negative women. BM samples from HIV-negative women were spiked with HIV-1 virions or cells containing a single integrated copy of HIV DNA (8E5/LAV). After incubation under different experimental conditions, viral RNA was detected by the Roche Amplicor UltraSensitive assay in whole-milk, skim milk, and lipid fractions. We found excellent correlation between HIV-1 input copy and recovery in whole milk (r = 0.965, P < 0.0001), skim milk (r = 0.972, P < 0.0001), and the lipid fraction (r = 0.905, P < 0.001). PCR inhibition was observed in less than 10% of the spiked samples. Similar levels of inhibition were noted in BM samples collected from HIV-infected women. HIV proviral DNA was detected in BM samples using real-time PCR (linear correlation between the threshold cycle versus log DNA copy number, >0.982). The effects of incubation duration and temperature and repeated freeze-thaw cycles on HIV RNA recovery were analyzed. HIV RNA levels were remarkably stable in whole milk after three freeze-thaw cycles and for up to 30 h at room temperature. Our findings improve the understanding of the dynamics of HIV detection in BM and the conditions for BM sample collection, storage, and processing.

Changes in TH1/TH2 immunity after endovascular and conventional infrarenal aortic aneurysm repair: its relevance for clinical practice

OBJECTIVE

to evaluate local surgical trauma induced by endovascular (TPEG) and conventional infrarenal aortic aneurysm repair (AAA-C), the inflammatory response and changes in cell-mediated and antibody-mediated immunity as illustrated by the type-1/type-2 T-helper (TH1/TH2) cell balance were investigated.

DESIGN

prospective study.

PATIENTS AND METHODS

sixteen patients were included, eight patients underwent AAA-C and eight TPEG. Venous peripheral blood samples were collected 24h preoperatively and 24, 48, 72h, 5 and 7 days postoperatively. Besides the WBC, intracellular TH1/TH2 cytokines (IFN-gamma/IL-4) and the cell surface markers HLA-DR on monocytes and CD23 on B cells were measured by four colour flow cytometry.

RESULTS

statistically significant higher values in the AAA-C group were demonstrated for neutrophiles. The TH1/TH2 immunobalance (expressed by forming the ratio of IFN-(gamma/IL-4 producing T cells as well as by the ratio of HLA-DR(pos) monocytes/CD23(pos) B-cells) showed a significant shift towards TH2 immunity in the AAA-C group whereas TPEG led to a significant lesser shift 24-72h after surgery (p < 0.05).

CONCLUSIONS

TPEG leads to a minor distortion of the TH1/TH2 immunobalance. This implies that TPEG is a less stressing procedure, that is especially beneficial in patients whose conditions are considered less suitable for AAA-C due to age and serious comorbidity.

Massives lokalisiertes Lymphödem - eine seltene Entität

Massive localized lymphedema is a rare disease. Only a few cases have been described in the literature. These monstrous pseudotumors of the subcutis are mostly localized in the inguinal region or at the lower extremity. These tumors often show a slow growth for many years. Besides hernias, lipomatous tumors must be distinguished. The therapy of choice is the excision of the tumor. Relapse is not uncommon in the few cases described in the literature so far. The diagnostic procedure and therapy of an 48-year-old women with a massive localized lymphedema weighing about 22 kg are demonstrated and discussed.

Effects of hyperbaric (6 ATA) pressure on voluntary and evoked skeletal muscle contractile properties

The objective of this study was to investigate the effect of 6 atmospheres of pressure (ATA) on plantar flexors' (PF) voluntary force and activation, force-frequency characteristics, and rate of torque development (RTD). Eight subjects performed PF isometric contractions. Muscle activation was monitored by electromyographic (EMG) activity (PF and dorsiflexors) and the interpolated twitch technique (ITT). Maximal evoked contractions of the PF were elicited at 1, 2, 3, 5, 10, 20, and 40 Hz. PF RTD was calculated with maximal voluntary, 1 and 40 Hz contractions. Hyperbaric pressures significantly decreased PF voluntary torque; 6.2%, ITT activation; 2.8% with a trend for a 19.1% decrease in EMG (p = 0.1). There were no significant differences in the dorsiflexors/PF EMG ratio. One Hz torque was potentiated 15.7% with an increased absolute RTD of 12.8%, but no change in relative RTD. The results suggested hyperbaric-induced decreases in PF activation contributed to voluntary torque loss. A lack of torque reduction with higher frequency tetanic stimulation (2-40 Hz) suggested that 6 ATA does not impair myofilament kinetics, whereas twitch potentiation may include changes in excitation-contraction coupling.

Practical fast gas chromatography for contract laboratory program pesticide analyses

An approach to shortening the analysis time for practical fast gas chromatography (GC) by using Method Translator software, which can be downloaded free from the Internet, is presented. This software simplifies the process of optimizing temperature programming while changing column dimensions, carrier gas type, and flow. Basic chromatographic theory is employed in a practical manner for adjusting column dimensions for optimal performance. In addition, electronic pneumatic control and high oven ramp rates make it easier to achieve fast analysis times without reproducibility problems. This practical approach is demonstrated using Contract Laboratory Program pesticide analytes. The factors found to be most important in decreasing the analysis time without a loss of performance are utilization of GC columns having smaller diameters and substitution of hydrogen for helium as the carrier gas.

Use of the Polyflex stent in the palliative therapy of esophageal carcinoma: results in 14 cases and review of the literature

BACKGROUND

Several prospective randomized trials have shown that self-expanding stents have advantages over conventional plastic tubes. Nevertheless, the optimal stent has not yet been developed. The Polyflex stent is a completely new model that represents an improvement over the old metal stents. We have used this stent in a prospective study and herein our present preliminary results.

METHODS

In 14 patients with nonresectable esophageal carcinoma, the Polyflex stent was implanted to reduce dysphagia. The grade of dysphagia, the complications following intervention, and the patients' total survival time were documented prospectively every 4 weeks.

RESULTS

The implantation of the stent was successful in all cases. The grade of the dysphagia was reduced from 3.0 to 0.5 after stent implantation. One patient died during the hospital stay from a non-stent-induced complication. Stent dislocation occurred once, and tumor overgrowth at the stent margins was observed twice. The mean survival time was 6.2 months, and the reintervention rate was 21.3%.

CONCLUSION

The new Polyflex stent, which is based on a completely new design, can be implanted without any difficulty and has had very good short- and long-term results. Therefore, it is a worthy alternative to the metal stents in current use.

Comparative evaluation of five in vitro tests for assessing the eye irritation potential of hair-care products

This study compared five methods, the isolated rabbit eye (IRE), bovine corneal opacity and permeability (BCOP), EpiOcular, fluorescein leakage (FL) and neutral red release (NRR) assays, for predicting the eye irritation potential of hair-care formulations. Ten shampoo and seven conditioner formulations of known ocular irritation potential were tested. Each group included a market-acceptable formulation as a comparative benchmark. Predictions of ocular irritation were made by using classification models (IRE, BCOP and EpiOcular assays) or by direct comparison with benchmarks (IRE, EpiOcular, FL and NRR assays). The BCOP assay was less sensitive than the IRE test in discriminating between formulations of different irritation potentials, and did not perform as well as the other assays in identifying mild formulations. All of the assays appeared to be better at discriminating correctly between the shampoos than between the conditioners. The EpiOcular assay showed the closest concordance between the in vivo results and the in vitro data from cell-based assays (particularly for shampoos). The FL assay also showed a high concordance (particularly for conditioners). There was a tendency for these in vitro assays to over-predict eye irritation potential, but there was no under-prediction and they were particularly successful at identifying mild formulations. The NRR assay was less predictive with both shampoos and conditioners. The results from this comparative evaluation fully support the continued use of the IRE test as a suitable alternative to in vivo eye irritation testing in rabbits, although it also over-predicted the irritancies of several of the formulations. The value of using concurrent benchmarks (reference standards), appropriate to the materials being tested, in interpreting the data obtained from in vitro tests, was also demonstrated. Overall, the results indicate that further comparisons of the IRE, EpiOcular and FL assays are warranted using much larger numbers of test materials.

[Aortic rupture in Behçet's disease]

Behçet's disease is a vasculitis of unknown aetiology, which becomes apparent by ocular and mucocutaneous symptoms. In rare cases, owing to vasculitis of the vasa vasorum of large arteries, necrosis of the vascular wall and thus spurious aneurysms occur. The case of a 41-year-old patient is described who presented with a rupture of an infrarenal aortic aneurysm due to Behçet's disease. Therapy consisted of placement of an aortic-aortic Dacron prosthesis. On the basis of the case report, the diagnostic approach, the therapy and the value of secondary prophylaxis of Behçet's disease are discussed.

Effect of organizational change on the individual employee

Increasing market pressures force companies to implement drastic organizational changes in order to remain competitive. Budget decreases, reduction efforts, and similar changes create significant morale and job-satisfaction concerns. This study assesses the effects of budget reductions and other organizational changes on the morale of hospital employees. A survey dealing with employee perceptions of stress, workload, and performance was given to hospital employees. Not surprisingly, the survey found that morale problems resulted from the organizational changes. Employees' gender and job classification showed little significant effect on the survey results, while respondents' length of employment with the organization influenced the results slightly. The findings provide information useful for dealing with challenges of employee satisfaction, morale, and trust during times of budget limitations.

Increased susceptibility to apoptosis in circulating lymphocytes of critically ill patients

BACKGROUND AND AIMS

Lymphocyte apoptosis may influence immune responsiveness in systemic inflammation. Therefore, we investigated whether early signs of apoptosis (i.e., annexin-V binding and cell shrinkage) in peripheral lymphocytes were different among patients with severe sepsis, critically ill, nonseptic patients after major surgery, and healthy individuals.

PATIENTS/METHODS

Ten patients with severe sepsis and ten critically ill, nonseptic patients after major surgery admitted to a surgical intensive care unit in a university hospital were included in the study. In addition, ten healthy blood donors were included for comparison. We investigated early signs of apoptosis using flow cytometric measurement of annexin-V binding to the cell surface and cell shrinkage of peripheral lymphocytes.

RESULTS

The percentage of apoptotic lymphocytes determined as annexin-V positive and propidium iodide negative cells was increased in freshly prepared cells of patients with severe sepsis (11.4 +/- 0.5%) and critically ill, nonseptic patients after major surgery (18.5 +/- 2.0%) relative to healthy blood donors (4.4 +/- 0.5%) (P < 0.05). No significant difference between patients with severe sepsis and patients after major surgery were found. Annexin-V binding increased significantly after OKT-3 stimulation of lymphocytes in patients with severe sepsis (34.4 +/- 1.6%), patients after major surgery (33.8 +/- 3.4%), and healthy blood donors (21.1 +/- 2.8%). No significant difference among groups was detected following OKT-3 stimulation. Furthermore, freshly isolated peripheral lymphocytes of patients with severe sepsis and critically ill, nonseptic patients after major surgery revealed a significantly higher proportion of cell shrinkage than in healthy blood donors (55.0 +/- 2.2%, 21.5 +/- 2.4% vs 3.6 +/- 0.7%; P < 0.05).

CONCLUSION

Circulating lymphocytes of critically ill patients show a high degree of early signs of cellular apoptosis. This may contribute to hyporesponsiveness of immune cells in systemic inflammation.

Myelodysplastic syndrome at a large tertiary care community hospital: analysis according to the international prognostic scoring system

The outcome of patients diagnosed myelodysplastic syndromes (MDS) between 1990 and 1997 from William Beaumont Hospital (WBH) was analyzed according to the International Prognostic Scoring System (IPSS) risk categorization. A retrospective study of 195 MDS patients wa s performed. Seventy-nine patients with MDS, in whom a karyotype was obtained and with an adequate follow-up were included in the final analysis. Cases of proliferative CMML (WBC > 12x10(9)/l) were excluded from the study. The overall median survival was 3.1 years, and median survival stratified by IPSS was 3.4, 4.1 and 0.5 years for the INT-1, INT-2 and high risk group and not yet reached for the low risk group. The overall survival by IPSS subcategorization were 6.88, 5.29, 5.30 and 2.12 years for the low, INT-1, INT-2, and high risk groups respectively. Cytogenetics were significant in predicting the overall survival. The IPSS score stratified patients into risk categories for development of AML. The risk of development into AML was 8, 8, 33 and 54% for the low, INT-1, INT-2 and high risk groups, respectively. We conclude that IPSS score can be useful in predicting survival and AML evolution in some MDS patients.

Impaired inducibility of heat shock protein 70 in peripheral blood lymphocytes of patients with severe sepsis

OBJECTIVE

To determine the extent of the potentially protective heat shock protein 70 response in peripheral blood lymphocytes of patients with severe sepsis after ex vivo lipopolysaccharide stimulation.

DESIGN

Entry study of consecutive patients with severe sepsis, those who were critically ill or nonseptic after major surgery, and healthy blood donors.

SETTING

Surgical intensive care unit in a university hospital.

PATIENTS

Ten patients with diagnoses of severe sepsis; ten critically ill, nonseptic patients after major surgery; and ten healthy blood donors.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

We investigated the ex vivo endotoxin-inducible expression of heat shock protein 70 in peripheral blood lymphocytes of patients with severe sepsis by means of flow cytometry. Only negligible amounts of inducible intracellular heat shock protein 70 accumulation (<4.2% of lymphocytes) could be detected in peripheral blood lymphocytes without lipopolysaccharide stimulation. The proportion of cells accumulating heat shock protein 70 after treatment with lipopolysaccharide was distinctly lower in patients with severe sepsis (p < .05) than in critically ill, nonseptic patients after major surgery and healthy blood donors (38.3+/-3.3%, 82.2+/-4.5%, and 70.9+/-3.9%, respectively; mean +/- SEM; n = 10). Patients with clinical signs of recovery from severe sepsis showed an increase in heat shock protein 70 expression.

CONCLUSIONS

Inducibility of ex vivo heat shock protein 70 was impaired in peripheral blood lymphocytes of patients with severe sepsis. The impaired expression of the potentially protective heat shock protein 70 may contribute in vivo to immune dysfunction, because intact functioning of T and B lymphocyte responses is of central importance in resisting infection in severe sepsis. Monitoring of inducible heat shock protein 70 in peripheral blood lymphocytes may contribute to the evaluation of the immune consequences of severe sepsis.

Endoscopic vs conventional hernia repair from an immunologic point of view

BACKGROUND

In this study we tried to estimate the local surgical trauma in patients undergoing endoscopic or conventional hernia repair via the changes in peripheral blood T cell subpopulations (i. e., T-helper 1 (TH1) and TH2 cells), recently shown to be recruited differentially to inflammatory sites.

METHODS

Cells were identified flow-cytometrically by intracellular cytokine staining on a single cell level in 30 patients undergoing conventional (Shouldice) or total extraperitoneal patch (TEPP) hernia repair.

RESULTS

The TH1 cells decreased postoperatively in Shouldice patients on an average of 20.8-31.4%, whereas in TEPP patients only a minor decline (mean, 7.8-9.2%) was observed. The TH2 cells did not change significantly in TEPP patients, and a small increase (mean, 7.7%) was detected in Shouldice patients.

CONCLUSIONS

Our results suggest that the postoperative reduction in TH1 cells reflects local surgical trauma and can be helpful in evaluating different surgical procedures. When conventional and endoscopic hernia repair were compared, the latter proved less traumatizing.

[The employment schedule act from the viewpoint of the ordinary surgeon]

In Germany, the law of labor time was instituted in hospitals on January 1st, 1996 to regulate working hours, times of rest, breaks, and Sunday and holiday work. Problems in the realization of this law arise in daily practice, especially with regard to maximum working hours and post on-call times of rest. The compliance with the law would necessitate an enormous increase in new jobs for physicians, which is associated with an unfinanceable rise in costs. Solutions are either a reduction in performance or the omission to document the productivity. Therefore, surgeons in salaried employment in German hospitals constantly face the conflict of legality and legitimacy.

[Increased CA-19-9 caused by a splenic cyst: a rare differential diagnosis]

Adenocarcinoma of the gastrointestinal tract, particularly primary adenocarcinoma of the pancreas lead to elevation of serum carbohydrate 19-9 (CA19-9) levels. Some benign disorders, like inflammatory diseases also cause CA19-9 tumor marker elevation. An extremely rare entity are benign splenic cysts which express this tumormarker as reported here.

[Palliative therapy of esophageal carcinoma]

For palliative endoscopic treatment of malignant dysphagia many different techniques are practiced. The differentiated usage of all techniques depending on the characteristics of the tumor leads to a good result with favorable costs. The following differentiated palliative regimen is presented: in the cervical part of the esophagus laser therapy or stent implantation are used, depending on the type of tumor growth. In the center section and the distal part of the esophagus usually palliative endoscopic pertubation is performed. If the stenosis is very soft and short a stent is implanted as alternative. In the gastroesophageal part flexible stents achieve the best results. Alternative laser therapy can be used.

[Women in surgery--equal surgeons]

In the specialty "surgery" women are underrepresented, especially in leading positions. The reason for that is not less motivation, less ability or less capacity of women, but the working conditions. For women in surgery working conditions are so unfavourable that only few women make their career in surgery.

Skin2--an in vitro human skin model: the correlation between in vivo and in vitro testing of surfactants

The availability of an in vitro test system to replace animal testing of potential irritants is becoming more and more urgent especially in Europe as a consequence of the European Community Cosmetics Directive. To evaluate the ability of Advanced Tissue Sciences' (ATS) ZK1301 skin model to predict the skin irritation potential of surfactants, we performed a pilot validation study utilizing four different laboratories. The in vitro protocol was designed as a quantitative pre-screen for the clinical patch studies. Sixteen substances, representing various surfactant categories and ranges of irritation potential, were tested. The 3-[4,5-Dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) assay was used to quantitate viability in vitro. We documented the viability of tissues exposed to unknown substances for specific periods. The in vitro results were calculated as percent distilled water controls (DWC). The time required to reduce the viability of each tissue to 50% of the distilled water controls (T50) was compared to mean erythema and edema scores from the clinical studies by Pearson's correlation. The individual laboratories demonstrated coefficients of 0.72. The results indicated that the 30 min percent untreated control values best predicted the 24 h clinical patch scores. No statistically significant interlab variability was found. Only one false negative was seen when non/mild and moderate/severe irritant categories were assigned according to the in vitro scores. These results demonstrate that the skin2 in vitro test system may serve as a good screening method prior to clinical patch studies.

[Forensic aspects of complicated laparoscopic cholecystectomy]

As laparoscopic cholecystectomy becomes more established, interest in legal aspects increases. The legal cases dealt with in Germany since the introduction of this laparoscopic method in 1989 were studied to determine the legal consequences of complications. Of 40 cases, 16 were judged to be cases of malpractice, whereas 24 were not. The most common cause was injury of the common bile duct (26 cases). Seven of these 26 cases were judged to be cases of malpractice, 2 of these as grave errors. The main reasons for the acceptance of a case as malpractice were delay in changing to conventional cholecystectomy, delayed revision, laparoscopic revisions and not reverting to conventional cholecystectomy in unclear situations.

[Changes in the cytokine concentration (Il-6, Il-8, Il-1ra) and their cellular expression of membrane molecules (CD25, CD30, HLA-DR) after surgical trauma]

Elective surgical approaches and trauma cause changes in the production of different cytokines, an increased production of acute phase protein and changes in the expression of different cell surface markers.

METHODS

In a prospective study we examined the C-reactive protein level, the production of the cytokines IL-6, IL-8 and IL-1 RA in 25 laparoscopic and 21 conventional cholecystectomies. In addition the cell surface markers CD25 and CD30 on different cell populations and HLA-DR on monocytes were measured. Statistical analysis was made by Student's-t-test and Mann-Whitney's rank sum test.

RESULTS

The humoral markers showed a more distinct increase in patients operated on conventionally two and 24 hours after surgery, the differences between the two surgical approaches were significant (p < 0.01). The cell surface markers CD25 and CD30 showed the same reaction. The HLA-DR expression on monocytes was significantly lower in patients operated on conventionally.

CONCLUSIONS

Elective surgical approaches cause changes in the immune system, which can be evaluated by the reaction of cytokines and cell surface markers. Laparoscopic cholecystectomies cause less activation of the immune system than conventional operations.

Clinical importance and prognostic value of the image-DNA-cytometry for patients with gastric cancer

Image-DNA-cytometric analysis was performed retrospectively on air-dried touch preparations from gastric carcinoma from 122 patients who underwent surgery from 1989-1994. The results of DNA cytometry were compared with conventional histologic staging and grading. Aneuploidy could be verified in 81 cases (66.3%), and a significant correlation was demonstrated between aneuploidy and a high incidence of lymph node metastases, whereas no correlation with tumor type and histologic grade was detected. Thus DNA ploidy may by useful in predicting prognosis in gastric cancer.

Automated sputum screening with PAPNET system: a study of 122 cases

The use of interactive, computerized PAPNET system (Neuromedical Systems, Inc, Suffern, NY) for screening of cervicovaginal smears has been favorably evaluated in several studies. In this article, the authors report on the performance of this apparatus on smears of sputum. One hundred twenty-two randomly selected, single slides of sputum specimens from an equal number of patients were subjected to PAPNET scanning. These Papanicolaou-stained slides were previously classified as inadequate, six; negative, 81; atypical, three; suspicious, one; and positive for malignant cells, 31. Images selected by PAPNET were reviewed by two observers, who were blinded to earlier interpretation and triaged into two categories: negative and review. Of the 31 smears with cancer cells, 30 were appropriately identified by PAPNET (sensitivity: 97.1%). The only case missed by PAPNET was that of small cell carcinoma that contained a single cluster of neoplastic cells. PAPNET also triggered the review of 20 of the "negative" cases, which on re-evaluation were identified as bronchial cells with squamous metaplasia and altered benign squamous cells of inflammatory type. A prospective study of PAPNET for screening of sputum samples is needed to establish the clinical value of this methodology.

Surgical stress induces a shift in the type-1/type-2 T-helper cell balance, suggesting down-regulation of cell-mediated and up-regulation of antibody-mediated immunity commensurate to the trauma

BACKGROUND

Measuring serum cytokines, pituitary hormones, or acute phase proteins during or after surgery is not an optimal method for quantifying the impact of surgical procedures. In an effort to assess surgical stress by means of the immune response, we focused on changes in cell-mediated and antibody-mediated immunity as illustrated by the type 1/type 2 T-helper (Th1/Th2) cell balance. The sensitivity of this approach was evaluated by comparing laparoscopic and conventional cholecystectomy (LCE, CCE).

METHODS

In a pragmatic prospective study 43 patients with symptomatic cholelithiasis were operated on either by LCE (n = 25) or CCe (n = 18). Blood sampling was done 24 hours before surgery, immediately before incision, and 2, 24, and 48 hours after surgery. Cell surface markers and cytokine production were used to characterize the Th1/Th2 balance and were measured by means of flow cytometry and enzyme-linked immunosorbent assay techniques.

RESULTS

Activation of Th2 cells evokes the production and secretion of interleukin-4 (IL-4), which up-regulates the expression of immunoglobulin E receptors (Fo epsilon RII, CD23) on B cells. Phytohemagglutinin-induced IL-4 production in freshly isolated peripheral blood mononuclear cells from patients increased more after CCE than LCE (IL-4, +41% versus +17%; p < 0.05). Also the expression of CD23 on B cells was higher after CCE than LCE (+146% versus +63%; P < 0.01). CD30, a membrane molecule that belongs to the tumor necrosis factor receptor superfamily and probably is an important indicator of Th2 activity, was more evaluated on T cells from patients who underwent CCE. The Th1 response, characterized by phytohemagglutinin-induced IFN-gamma secretion in peripheral blood mononuclear cells and up-regulation of human leukocyte antigen-DR expression on monocytes, was lower after CCE than after LCE.

CONCLUSIONS

This study shows that surgical stress induces a shift in the Th1/Th2 balance toward Th2, suggesting that cell-mediated immunity is down-regulated and antibody-mediated immunity is up-regulated after surgery. The evaluation of this shift may be clinically meaningful and help quantify even less invasive surgical procedures. When comparing CCE and LCE in this not strictly randomized study, we found LCE to be the less stressful procedure.