Protamine sulfate enhances lipid-mediated gene transfer

OBJECTIVE: To analyze myoelectric activity of the cecum and proximal loop of the ascending colon (PLAC) in cows after spontaneous cecal dilatation/dislocation (CDD) and compare it with that in healthy cows after surgical evacuation of the cecum. ANIMALS: 12 cows with spontaneous CDD and 6 healthy cows (group C). Cows with spontaneous CDD were retrospectively assigned to 2 groups: delayed recovery from surgery or recurrence (group A; n = 3), and normal recovery (group B; n = 9). PROCEDURE: After surgical evacuation of the cecum, 8 pairs of bipolar, retrievable electrodes were implanted in the ileum, cecum, and PLAC. Cows were evaluated daily from postoperative day 1 to 7, using routine clinical methods and computer-based analysis of myoelectric activity of the cecum, and PLAC. Parameters of myoelectric activity included rate of spike bursts, duration of individual spike bursts, duration of overall spike burst activity per electrode, rate of propagated spike burst sequences, and ratio of orally propagated spike burst sequences. RESULTS: Rate of spike bursts, duration of cecocolic spike burst activity, and ratio of orally to aborally propagated spike burst sequences did not vary among groups during the 7-day recording period. However, cows with delayed recovery had a typical, uniform pattern of myoelectric activity of the cecum and PLAC at days 1 and 2 after surgery that consisted of repeated, propagated spike burst sequences, made up of spike bursts of significantly (P < 0.05) increased duration at postsurgical day 1 and substantially prolonged duration at postsurgical day 2, interrupted by periods of little or no activity. CONCLUSION: Delayed recovery and recurrence of CDD in cows after spontaneous CDD is not caused by hypomotility of the cecum and PLAC. CLINICAL RELEVANCE: Postoperative treatment, intended to reduce recurrence of CDD or delayed recovery after surgical evacuation of the cecum, should address propagation of digesta in the spiral colon.     

Gangrene and spontaneous perforation of the cecum as a complication of pseudo-obstruction of the colon: report of three cases and speculation as to etiology

"Pseudo-obstruction of the colon" refers to a condition in which physical and radiologic findings identical to those associated with mechanical obstruction of the large bowel are found, but in which no organic cause of colonic distention can be identified. These cases may involve progressive proximal large-intestinal dilation to the point of cecal perforation or necrosis. Two cases of spontaneous perforation of the cecum and one case of gangrene of the cecum secondary to proximal distention of the right colon that followed pseudo-obstruction of the colon are presented. Various etiologic factors reported in the medical literature are discussed and analyzed, and an anatomicophysiologic explanation of a possible mechanism, based on sympathetic-parasympathetic neurostimulatory imbalance, is offered.     

Diffuse polyposis of the large intestine as a precancerous condition]

In 86 (49.4%) of 173 patients cancer of the colon of various localizations against the background of diffuse polyposis was diagnosed, rectal involvement being noted in 50%, cancer involvement of the cecum involvement of the cecum and ascending colon--in 5.4% and 7.2% accordingly. These data made it possible to revise an existing concept of preservation of the rectum in radicalsurgery for diffuse polyposis in favour of remaining right portions of the colon.     

Right hepatic lobe atrophy in horses: 17 cases (1983-1993)

The case records of 17 horses with atrophy of the right hepatic lobe were reviewed. Fifteen horses had signs of colic. Two horses had clinical problems that were unassociated with gastrointestinal tract disease. Ages ranged from 5 to 30 years (mean, 12.6 years) and there was no breed or sex predisposition. In clinically normal horses, the right hepatic lobe constitutes half of the total liver weight. The right hepatic lobe in the 17 horses in this study ranged from 11.0 to 38.3% of the total liver weight (mean, 27.8%). Findings on histologic examination of hepatic tissue from horses in the study were variable. Most had loss of hepatocytes, with condensation of hepatic stroma and thick wrinkled hepatic capsules. Additional findings in the horses included torsion of the large colon (15), ileus without gastric rupture (3), typhlocolitis (2), colon infarction secondary to mesenteric strangulation (1), colon infarction secondary to sepsis (1), strangulation of the small intestine from pendulous lipoma (1), and nephrosplenic entrapment (1). No morphologic evidence of angiopathic disease involving the arterial or venous blood supply to the right hepatic lobe was found. Additionally, there was no evidence of biliary tract disease in this portion of the liver. Right hepatic lobe atrophy is believed to result from long-term, insidious, compression of this portion of the liver from abnormal distention of the right dorsal colon and base of the cecum. The practice of feeding horses high-concentrate, low-fiber diets may contribute to atony of the right dorsal colon, with resultant distention that compresses the right hepatic lobe against the rigid, visceral surface of the diaphragm.     

Severe stenosis of the right coronary artery in a 15-year-old girl with type IIa hypercholesterolemia: successful treatment with stent implantation

Coronary artery stenosis with need for therapy is rarely seen in childhood. A 15-year-old girl with hypercholesterinaemia type II a was undergoing lipid aphereses therapy (once or twice a week) since she was 6 years old. The girl was seen in our hospital with stenocardia and depression of the ST-segment in the inferior ECG leads at rest. Myocardial scintigraphy with technetium 99 showed an ischemia of the infero-lateral left ventricular myocardium. During selective coronary angiography a 90% stenosis of the proximal right coronary artery over a distance of approximately 5 mm close to the ostium was found. Post stenotic dilatation of the vessel was obvious. In addition a diffuse 10% stenosis in the proximal and middle part of the right coronary artery was found. The left coronary artery appeared angiographically normal. After balloon dilatation, stent implantation was performed without complications with a 6 mm microstent. Reduction of the stenosis from 90% to 40% could be achieved. Ticlopidin 2 x 250 mg was started for thrombocyte aggregation inhibition. During the following 12 months the patient has been free of symptoms. Lipidaphareses has been continued as before. Stent implantation seems to be a successful treatment for coronary artery stenosis also in young patients.     

Acute epitrochlear lymphadenitis

Blunt trauma accounted for 1/3 of the 32 patients operated upon for injuries of the large intestine and penetrating wounds for 2/3. Most of the blunt injuries (9/10) were caused by traffic accidents, and more than half of the penetrating ones (12/22) were stab wounds. The transverse colon was most commonly affected, followed by the ascending, descending and sigmoid colon, rectum and mesentery. Perforation of the small intestine was the most frequent associated intra-abdominal injury, occurring in 11 patients (34%). Most patients (22/32) underwent simple suture, 6 patients suture with proximal colostomy, 3 primary resection and one exteriorization, combined in all cases with broad-spectrum antibiotic coverage and drainage of the abdominal cavity. Injuries to the right and transverse colon were managed mainly with simple suture, and those to the left colon and rectum with suture and proximal colostomy. 50% of the patients had complications, most frequently wound infection and intra-abdominal abscess. The patients with simple suture had fewer complications than the others. In the absence of complicating factors injuries to the colon are best managed with simple suture, whereas in the presence of complicating factors and in injuries of the rectum, suture or resection with proximal colostomy, especially in cases of severe tissue destruction, remains the treatment of choice.     

Limited fat absorption in the large intestine of mice. A morphological study

A limited fat-absorbing ability of the epithelial cells in the cecum and colon of mice was demonstrated light- and electron-microscopically. After injection of predigested donor fat into ligated segments of the large intestine and after massive gastric intubation of fat, fat droplets, predominantly of extremely large diameter, were visible in the cecum and colon. Comparison with fat absorption in the proximal and distal small intestine was undertaken. The large intestine, similar to the distal small intestine, is capable of absorbing lipids; however, the subsequent processing of fat appears considerably less effcient than in the proximal segments of the small intestine.     

Subparietal hepaticojejunal access loop for the long-term management of intrahepatic stones

BACKGROUND: The subparietal hepaticojejunal biliary access loop is a recognized technique for the long-term management of primary intrahepatic stone disease. This paper assesses the results of this approach in a series of South African patients. METHODS: Between 1985 and 1997, 21 patients, of mean age 34 (range 24-66) years, underwent surgical extraction of intrahepatic stones and formation of an hepaticojejunal access loop. The access loop was subsequently used for further stone removal and stricture dilatation. Patients were followed prospectively (median 47 months) and details of the number and type of procedures performed, stone clearance rates, morbidity and subsequent outcome were recorded. RESULTS: The distribution of intrahepatic stones was left lobe in 13 of 21 patients, right lobe in one and bilateral in seven. Six patients underwent additional left lobectomy at the initial operation because of associated atrophy of the left lobe. Following operation, stone removal and/or stricture dilatation was performed on 97 occasions (median 4 (range 0-24) procedures per patient). Complete stone clearance was achieved in 17 of 21 patients with partial clearance in the remaining four. There were no major complications and no deaths associated with the procedures. CONCLUSION: The subparietal access loop permits long-term access to the intrahepatic ducts allowing removal of stones and dilatation of strictures with minimal patient discomfort and low morbidity.     

External tibial torsion: an underrecognized cause of recurrent patellar dislocation

Seventeen patients (18 knees) with recurrent patellar dislocation were identified with increased quadriceps angles secondary to excessive isolated external tibial torsion. Traditional realignment procedures attempted in these knees were unsuccessful because of failure to align the biomechanical axis of the extensor mechanism. Derotational osteotomies of the tibia just proximal to the patella tendon insertion were used to reduce the quadriceps angle to within normal limits to improve the biomechanics of the extensor mechanism. Seventeen (94%) knees were available for clinical and subjective followup at an average of 25 months (range, 1-3.2 years). Overall, 13 of the 17 knees were graded as good to excellent (76%). Five of the 17 patients also had well established anterior knee pain in addition to recurrent dislocation and were treated with a combined derotational and Maquet type osteotomy, with 4 patients obtaining a good to excellent result. Knees that subjectively and functionally demonstrated less painful symptoms preoperatively were associated with excellent results. Poor outcomes were associated with knees that were operated on multiple times.     

Enhanced detection of proximal right coronary artery stenosis with the additional analysis of right ventricular thallium-201 uptake in stress scintigrams

The value of right ventricular thallium-201 analysis in detecting proximal right coronary artery stenosis in exercise myocardial scintigraphy was analyzed in 52 patients, 27 with and 25 without proximal right coronary artery stenosis. For the detection of proximal right coronary artery stenosis, the sensitivity and specificity of thallium scintigraphic analysis were 59 and 88% for a right ventricular abnormality, 67 and 68% for a left ventricular inferior wall abnormality, and 93 and 56% for an abnormality of either. When both right and left ventricular thallium images were abnormal, all 9 patients had proximal right coronary artery stenoses, and when both were normal, 26 of 28 patients had a normal proximal right coronary artery. The sensitivity and specificity of blood pool scintigraphic variables during exercise (right ventricular ejection fraction and left ventricular inferior wall motion) were not significantly different for detection of proximal right coronary artery stenosis. Thus, the additional analysis of the right ventricle on thallium-201 stress scintigrams can improve the detection of proximal right coronary artery stenosis. When both right ventricular and left ventricular thallium scintigrams are abnormal (or normal), the ability to predict the presence (or absence) of proximal right coronary artery stenosis is very high.     

Colon cancer with a high serum alpha-fetoprotein level

We report on a patient with colon cancer and a very high serum alpha-fetoprotein level. This 75-yr-old man presented with right lower quadrant abdominal pain. An abdominal CT scan as well as ultrasonography showed a tumor in the cecum. Serum alpha-fetoprotein level was extremely high (3,070 ng/ml). At laparotomy, a large mass was found in the cecum, and a right hemicolectomy was performed. Histological examination, including immunohistochemical study, showed an adenocarcinoma of the colon producing alpha-fetoprotein.     

The effects of various diphosphonates on a rat model of cardiac calciphylaxis

Compartmental analysis of the disappearance curve of serum cholesterol specific activity after an intravenous administration of a tracer does of cholesterol-4-14C was carried out in five patients with resection of the distal small intestine, cecum, and proximal colon. The data fit best a two compartment model in all five cases with the rapidly exchangeable pool of 16.6+/-3.2 g (mean +/- SD, 60% of the mean of 15 normal subjects) and the slowly exchangeable pool of 31.5 +/- 10.9 g (65%). The reduction of the pool sizes was associated with a shorter mean transit time of cholesterol, 22.15 +/- 8.07 days (40%) and increased turnover rate, 2.42 +/- 0.72g/ day (172%). Direct fecal analysis for the neutral sterols and bile acids derived from the exchangeable pool confirmed the turnover rate obtained from the compartmental analysis. The increased fecal excretion was mainly in the bile acid fraction. The study suggests that the ileal and proximal colon resection results in bile acid malabsorption which, in turn, increases hepatic cholesterol and bile acid synthesis. The synthetic rates, however, could not compensate totally for the excretory rate. Therefore, the pool size decreased to a new low steady state of equilibrium.     

Surgical standards in primary colon cancer

The surgical standards in the treatment of primary cancer of the colon include the radical resection of the tumor-bearing colon with truncal ligation of its vessels. Eradication of the tumor with complete dissection of the lymphatic drainage area increases the chance for cure (R0). The lymphatic dissection determines the extent of colonic resection: right hemicolectomy (ileo-transversostomy) with truncal ligation of the iliocolic and right colonic arteries for carcinomas of the cecum and ascending colon; transverse colectomy (ascendo-descendostomy) with ligation of the middle colic artery for carcinomas in the middle of the transverse colon; left hemicolectomy (transverso-rectostomy) with ligation of the inferior mesenteric artery at the aorta for cancer of the descending and sigmoid colon; extended sigmoid resection (descendo-rectostomy) with central lymphadenectomy and ligation of the inferior mesenteric artery distal to the left colic artery for cancer of the distal sigmoid colon. Carcinomas located in between two drainage areas (lateral transverse colon, hepatic or splenic flexure) are treated by extended hemicolectomies or subtotal colectomies with dissection of two lymphatic drainage areas. The monobloc no-touch isolation technique requires the ligation of vessels prior to the mobilisation of the colon. Exceptions from these standard operations (limited resections) are necessary for metastatic disease or in the acute emergency situation of perforation or obstruction. Application of these surgical principles will ensure the best possible treatment results in primary colonic cancer.     

Severe rhabdomyolysis with renal failure after intranasal cocaine use

Torsion of a long bone is the twist along its longitudinal axis; torsion of the radius is defined by the angle between the proximal and distal metaphyses in the transverse plane. Measurement of the radial torsion angle provides a means of detection and quantification of malrotation after a fracture. The purpose of the current study was to develop and standardize a technique for the measurement of torsion of the radius. Axial computerized tomographic images of thirty-nine pairs of dry cadaver specimens of normal radii, and an additional four pairs of radii with a unilateral deformity of the distal metaphysis that was consistent with a previous fracture, were studied and a measurement protocol was established. The radial torsion angle was measured by three independent observers on two separate occasions. Reproducibility of the technique was determined with use of the intraclass correlation coefficient to express both interobserver and intraobserver reliability. Consistency of measurements between observers and by the same observer was high, with intraclass correlation coefficients ranging from 0.87 to 0.94. The mean torsion angle for the eighty-two normal radii in the study was 32.6 degrees (95 per cent confidence interval of the mean, 30.3 to 34.9 degrees; range, 1.4 to 58.8 degrees). There were small variations in torsion angle between the two radii of each normal pair (mean side-to-side difference, 4.9 degrees; 95 per cent confidence interval of the mean, 3.5 to 6.3 degrees). The mean torsion angle of the four radii with a malunited fracture was 10.4 degrees (95 per cent confidence interval of the mean, 5.7 to 15.1 degrees), and the mean side-to-side difference in the pairs containing these radii was 24.1 degrees (95 per cent confidence interval of the mean, 8.5 to 39.6 degrees; p < 0.0001 compared with the normal radii).     

A case of total cavopulmonary connection with preceding tricuspid valve closure in pulmonary atresia and intact ventricular septum, right ventricular-coronary artery fistulae, and coronary artery stenoses]

More than half of the patients with pulmonary atresia and intact ventricular septum (PA/IVS) are known to complicate right ventricular-coronary artery fistula (fistulae) and particularly those with coronary artery stenoses bear a high mortality rate and remain in a surgical challenge. A 4-year-old girl was first admitted to our hospital at 5 days of age and right ventriculogram revealed markedly hypoplastic tripartite ventricle and multiple fistulae through which both coronary arteries and aortic root were retrogradely opacified. Echocardiographically measured diameter of the tricuspid valve was 5 mm (Z value: 4). She underwent pulmonary valvotomy and central aorto-pulmonary (AP) shunt at 16 days of age. Repeat right ventriculogram at 1.9 years of age disclosed multiple stenoses in left anterior descending coronary artery (LAD) with proximal dilatation and tortuosity. Additional findings of left ventricular dysfunction (LVEF of 61.5%) and depressed ST segment in left precordial leads prompted us to proceed to the second palliation which comprised take-down of central AP shunt, bidirectional cavopulmonary shunt and closure of tricuspid and pulmonary valves. Catheterization at 3.4 years of age disclosed antegradely filled LAD with apparent relief of stenoses and improvement of LVEF to 68.9%. She underwent definitive repair of total cavopulmonary connection at 4.0 years of age and is leading a normal life 2 years after surgery. This experience draws us to conclude that tricuspid valve closure is a meaningful palliative procedure for PA/IVS with fistulae and coronary artery stenoses, provided that proximal segments of both coronary arteries remain intact.     

Dilatation of the left colon with a Foley catheter: an aid to staple anastomosis

Balloon dilatation of the left colon using a Foley catheter was performed in 26 patients prior to staple anastomosis. A 28-mm stapler was then used in six (23%) patients, a 29-mm in seven (27%), a 31-mm in eleven (42%) and a 33-mm in two (8%). Two anastomoses failed (7.9%) and one patient developed local recurrence. None of the remainder developed a symptomatic stricture. Flexible sigmoidoscopy was performed on 18 patients at least 3 months after surgery, revealing that one (5.5%) had developed an asymptomatic stricture. A 28-mm stapler had been used in this case. This technique of dilating the left colon with a Foley catheter is a useful aid to staple anastomosis in large bowel surgery.     

Possible pathogenic role of IL-16 on SLE: with reference to HIV-1 infection]

PURPOSE: To evaluate percutaneous embolotherapy in the treatment of lower gastrointestinal hemorrhage. MATERIALS AND METHODS: Twenty-one patients who underwent attempted percutaneous embolization for acute lower gastrointestinal bleeding between 1982 and 1997 were retrospectively studied. Hemorrhagic sites included jejunum (n = 4), ileum (n = 4), cecum (n = 4), and the remaining colon (n = 9). RESULTS: Embolization was not technically possible in four patients (19%). Hemostasis was achieved in 15 patients (71%) with prolonged hemostasis in 10 (48%). All embolizations distal to the cecum resulted in prolonged hemostasis. Three of four patients with jejunal bleeding had recurrent bleeding after apparent successful embolization. Only one of four cecal embolizations achieved prolonged cessation of bleeding. No ischemic complications were identified. CONCLUSION: Based on these data, it would appear that the risk of bowel ischemia/infarction in the lower gastrointestinal tract may not be as high as has been suggested. Two regions (cecum and proximal jejunum) were associated with poor results, suggesting these areas may not be as responsive to embolotherapy as other sites in the lower gastrointestinal tract.     

Length and torsion of the lower limb

Corrective osteotomies are often planned and performed on the basis of normal anatomical proportions. We have evaluated the length and torsion of the segments of the lower limb in normal individuals, to analyse the differences between left and right sides, and to provide tolerance figures for both length and torsion. We used CT on 355 adult patients and measured length and torsion by the Ulm method. We excluded all patients with evidence of trauma, infection, tumour or any congenital disorder. The mean length of 511 femora was 46.3 +/- 6.4 cm (+/-2SD) and of 513 tibiae 36.9 +/- 5.6 cm; the mean total length of 378 lower limbs was 83.2 +/- 11.4 cm with a tibiofemoral ratio of 1 to 1.26 +/- 0.1. The 99th percentile level for length difference in 178 paired femora was 1.2 cm, in 171 paired tibiae 1.0 cm and in 60 paired lower limbs 1.4 cm. In 505 femora the mean internal torsion was 24.1 +/- 17.4 degrees, and in 504 tibiae the mean external torsion was 34.9 +/- 15.9 degrees. For 352 lower limbs the mean external torsion was 9.8 +/- 11.4 degrees. The mean torsion angle of right and left femora in individuals did not differ significantly, but mean tibial torsion showed a significant difference between right (36.46 degrees of external torsion) and left sides (33.07 degrees of external torsion). For the whole legs torsion on the left was 7.5 +/- 18.2 degrees and 11.8 +/- 18.8 degrees, respectively (p < 0.001). There was a trend to greater internal torsion in femora in association with an increased external torsion in tibiae, but we found no correlation. The 99th percentile value for the difference in 172 paired femora was 13 degrees; in 176 pairs of tibiae it was 14.3 degrees and for 60 paired lower limbs 15.6 degrees. These results will help to plan corrective osteotomies in the lower limbs, and we have re-evaluated the mathematical limits of differences in length and torsion.     

Infants' localization of sounds along the horizontal axis: Estimates of minimum audible angle.

Localization acuity was examined by determining the smallest sound shift off midline and along the horizontal axis that infants could reliably discriminate (i.e., minimum audible angle). Infants 6, 9, 12, 15, and 18 months of age were seated in a dark room facing an array of nine loudspeakers positioned along the horizontal axis and at ear level. One loudspeaker was positioned at midline, 0°, and four others each were positioned to the right and left of 0°. A two-alternative forced-choice procedure was used in conjunction with a method of constant stimuli. A sequence of white-noise bursts was presented initially at 0° and was then shifted horizontally (right or left of 0°). The sequence continued to be presented until the infant made a directional head or eye movement, or both. Correct responses were visually reinforced. With increasing age, infants demonstrated a finer partitioning of auditory space along the horizontal axis. At 6 months, only a location shift of at least 12° off midline was reliably discriminated, whereas, by 18 months, infants reliably discriminated a shift of only 4°. (PsycINFO Database Record (c) 2010 APA, all rights reserved)