Effect of Storage Time and Temperature on Fecal Leukocytes and Occult Blood in the Evaluation of Travelers' Diarrhea

Background: Both the presence of fecal leukocytes and occult blood in stool specimens of travelers with diarrhea have been used as indicators of colonie inflammation due to bacterial infection. This study was conducted to determine if storage temperature of stool specimens can affect the detection of leukocytes and occult blood.
Methods: Sixteen specimens positive for occult blood and 23 specimens positive for leukocytes were divided into two aliquots. Each aliquot was held at 4°C or 25°C and reexamined daily for fecal leukocytes or occult blood.
Results: Four percent of the positive leukocytes specimens and 56% of the occult blood positive specimens were still positive on the fifth day when they were held at 4°C. When the samples were held at 25°C, leukocytes could not be detected after 3 days, but 19% were positive for occult blood on the fifth day.
Conclusion: The results indicate that storage temperature of stool specimens was associated with a difference in detection rate.     

奥美拉唑镁片防治中毒患者洗胃后急性胃粘膜损伤的效果观察

目的观察奥美拉唑镁片对中毒患者洗胃后急性胃粘膜损伤的防治效果.方法将103例口服毒物急性中毒患者随机分为2组,治疗组除给予解毒剂和补液对症治疗外,在彻底洗胃后给予奥美拉唑镁片首剂40 mg加温开水100 ml灌胃,次日起口服,每日1次,每次20 mg,疗程1周;对照组只给予洗胃、解毒剂和对症补液治疗.测定2组治疗前和治疗后3 d及1周后的胃液pH值,同时进行粪便潜血试验;治疗1周后作胃镜观察.结果治疗后两组胃液pH值上升和粪便潜血试验阳性结果及治疗1周后胃镜观察结果差异非常显著(P＜0.01).结论对口服毒物中毒患者急救的同时,早期应用奥美拉唑镁片治疗,能有效地预防和治疗中毒患者洗胃后急性胃粘膜损伤.     

A sensitive guaiac faecal occult blood test is less useful than an immunochemical test for colorectal cancer screening in a Chinese population

BACKGROUND: Colorectal cancer screening by guaiac faecal occult blood test has been shown to reduce the incidence and mortality of colorectal cancer in Western populations. The optimal faecal occult blood test, whether guaiac or immunochemical, for colorectal cancer screening in the Chinese population remains to be defined. AIM: To compare the performance characteristics of a sensitive guaiac-based faecal occult blood test (Hemoccult SENSA) and an immunochemical faecal occult blood test (FlexSure OBT) in a Chinese population referred for colonoscopy. METHODS: One hundred and thirty-five consecutive patients who were referred for colonoscopy and who met the study inclusion criteria took samples for the two faecal occult blood tests simultaneously from three successive stool specimens, with no dietary restrictions. All tests were developed and interpreted by a single experienced technician who was blind to the clinical diagnosis. The sensitivity, specificity and positive predictive value for the detection of colorectal adenomas and cancers were estimated for the two tests. RESULTS: The sensitivity, specificity and positive predictive value for the detection of significant colorectal neoplasia (adenomas > or = 1.0 cm and cancers) were 91%, 70% and 18% for Hemoccult SENSA and 82%, 94% and 47% for FlexSure OBT. The specificity and positive predictive value were significantly higher for FlexSure OBT than for Hemoccult SENSA (P < 0.001 and P = 0.016, respectively). Combining the positive results from both faecal occult blood tests did not improve the accuracy. CONCLUSION: The positive predictive value of the immunochemical faecal occult blood test for the detection of significant colorectal neoplasia was 29% better than that of the sensitive guaiac-based test. This may relate to the Chinese diet and requires further study. The poor specificity of the sensitive guaiac-based test, without dietary restriction, makes it less useful for colorectal cancer screening in a Chinese population.     

Influence of non-steroidal anti-inflammatory drugs on the outcome of faecal occult blood tests in screening for colorectal cancer.

Non-steroidal anti-inflammatory drugs have been accused of causing false positive results in faecal occult blood tests for colorectal cancer. A study was therefore performed in 10,931 people undergoing faecal occult blood screening tests to assess the effect of these drugs on the predictive value of a positive test result. Those with a positive result were interviewed and a full drug history was taken before they underwent a full colorectal examination. Of the 455 people with a positive result, 50 were taking non-steroidal anti-inflammatory drugs: 10 (20%) had colonic neoplasia. Of the 405 who were not taking non-steroidal anti-inflammatory drugs, 129 (32%) had colonic neoplasia. These detection rates were not significantly different, and the predictive value of a positive result for an adenoma larger than 1 cm was 14% in the group not taking anti-inflammatory drugs and 26% in the group taking them (not significant). These results suggest that a finding of occult faecal blood cannot be attributed to upper gastrointestinal tract bleeding caused by non-steroidal anti-inflammatory drugs and should be followed by a thorough colorectal examination.     

Effect of ibuprofen on lithium plasma and red blood cell concentrations

The effect of ibuprofen on steady-state lithium plasma and red blood cell concentrations was studied in 11 normal volunteers. During the seven-day control phase, sustained-release lithium carbonate 450 mg was administered every 12 hours. Lithium plasma and red blood cell concentrations were determined on days 5, 6, and 7. During the treatment phase (days 7-15), ibuprofen 400 mg was administered four times a day concurrently with lithium. Lithium plasma and red blood cell concentrations were obtained on days 14, 15, and 16. Multiple blood samples were obtained over a 12-hour period on days 6 and 15. Urine samples were collected from six subjects. The mean minimum lithium concentration increased 15% when ibuprofen was added. Mean maximum lithium concentration, area under the curve, red blood cell concentrations, and the lithium red blood cell to plasma ratio were significantly higher during the treatment phase. Mean lithium total body and renal clearance values were significantly lower during the treatment with ibuprofen. The administration of ibuprofen can increase steady-state plasma lithium concentrations and decrease lithium clearance.     

Do nizatidine and cimetidine interact with ibuprofen?

Summary The potential for interaction between ibuprofen and two histamine H₂-receptor blocking drugs — nizatidine and cimetidine — was investigated in six healthy male volunteers aged 20 to 25 years. Each subject received placebo, nizatidine 300 mg and cimetidine 800 mg orally at 9.00 p.m. daily for six doses in three randomised treatment periods separated by eight days. On the third day of each treatment period ibuprofen 400 mg was administered at the same time and venous blood samples were taken at intervals throughout the night and subsequently up to 84 h after administration.There was no difference in the area under the plasma concentration-time curve, rate of absorption or half-life of elimination of ibuprofen between the three treatments. The elimination half-life of ibuprofen on placebo was 2.04 h. The elimination half-life of nizatidine on ibuprofen was 1.72 h and that of cimetidine was 3.54 h. The latter is higher than previously reported in normal subjects.It is concluded that neither H₂-blocker affects the kinetics of ibuprofen in man.     

Comparative evaluation of a new bedside faecal occult blood test in a prospective multicentre study

BACKGROUND: Faecal occult blood testing is an established method of colorectal neoplasia screening. Guaiac-based tests are limited by poor patient compliance, low sensitivity, specificity and positive predictive value. Newer immunochemical-based tests, accurate but tedious, require a well-established laboratory set up. There is need for simpler immunochemical tests that can be performed at the out-patient clinic. AIM: To compare the performance characteristics of a new bedside immunological test strip device with a sensitive Guaiac-based and established immunochemical test for detection of faecal occult blood in patients undergoing colonoscopy. METHODS: A total of 389 consecutive patients from four centres who were referred for colonoscopy also provided the stool samples for detection of occult blood without dietary restrictions. Stool tests performed were (i) Guaiac-based, (ii) immunochemical enzyme-linked immunosorbent assay and (iii) bedside immunochemical strip test. RESULTS: At the optimal threshold level, the sensitivity and specificity of the beside immunochemical strip test for detection of significant colorectal neoplasia (adenomas >1.0 cm and carcinomas) were 60% and 95%, respectively. CONCLUSIONS: This bedside immunochemical strip test proved to be a simple, convenient, non-cumbersome and accurate tool with similar performance characteristics for detection of any bleeding lesion including colorectal neoplasia when compared with an established immunochemical faecal occult blood test.     

强骨胶囊正常人体耐受性研究

目的:观察正常健康志愿者对强骨胶囊的耐受性.方法:健康受试者32例,其中单次给药耐受性试验20例,分为小剂量组(0.09g)4例,中剂量组(0.18g)6例,中大剂量组(0.36g)6例,大剂量组(0.72g)4例,晨服1次;连续给药耐受性试验12例,分为小剂量组(0.18g,tid,连续服药42d)和大剂量组(0.36g,tid,连续服药42d),每组6例,分别比较单次给药和连续给药试验中给药前后受试者的临床症状和实验室化验结果的变化.结果:试验各组除连续给药耐受性试验的大剂量组中有1例出现轻度口干,1例出现便秘外,均未见到明显不良反应.各组用药前后心率、呼吸、体温、血压、心电图及血常规、尿常规、便常规、肝肾功能等指标均未见异常.结论:受试者对强骨胶囊具有较好的耐受性,推荐临床每次1粒(0.18g/粒),tid,建议临床用量不超过每次2粒,tid.     

A quantitative immunochemical faecal occult blood test is more efficient for detecting significant colorectal neoplasia than a sensitive guaiac test

BACKGROUND: The sensitive guaiac faecal occult blood test, Haemoccult SENSA (HOS; Beckman Coulter, Fullerton, CA, USA), is our standard screening test for significant colorectal neoplasia. We evaluated an automatically-developed, quantified human haemoglobin immunochemical faecal test, OC-MICRO (Eiken Chemical Co., Tokyo, Japan), to improve test specificity and so reduce the colonoscopy burden. AIM: To compare guaiac faecal occult blood test and immunochemical faecal test diagnostic efficacy and costs for identifying significant neoplasia. METHODS: Colonoscopies were performed on patients who prepared three daily guaiac faecal occult blood tests with or without immunochemical faecal tests. RESULTS: Total colonoscopy was performed on 151 subjects who prepared both guaiac and immunochemical faecal tests (group 1) and the positive predictive values (PPV) were also compared to those of 162 subjects undergoing colonoscopy for positive guaiac faecal occult blood tests (group 2). In group 1, comparative sensitivity, specificity, and PPVs for significant neoplasia with guaiac faecal occult blood test were 75%, 34%, and 12% (PPV, 18% for group 2) and with immunochemical faecal test were 75%, 94% and 60% (P < 0.01 for specificity). The number of colonoscopy examinations needed to detect a significant neoplasm because of positive faecal occult blood tests was six to eight with HOS and two with OC-MICRO at 21-31% the cost of evaluating a positive guaiac faecal occult blood test. CONCLUSION: An immunochemical faecal test maintains the high sensitivity of guaiac faecal occult blood test, but significantly reduces the colonoscopy burden and screening costs.     

左氧氟沙星致出血性膀胱炎

1例52岁女性患者因急性扁桃体炎口服左氧氟沙星0.2 g,3次/d。3 d后出现尿急、尿频、下腹痛,棕色尿液,尿中见血块,伴有排尿困难。实验室检查示尿隐血(+++)。超声检查提示急性膀胱炎。停用左氧氟沙星。停药第2天,尿色逐渐恢复正常。第5天尿常规结果正常。2用后超声检查示膀胱恢复正常。     

Albendazole residues in goat's milk: Interferences in microbial inhibitor tests used to detect antibiotics in milk

Albendazole (ABZ) residues in goat's milk and their effect on the response of microbial inhibitor tests used for screening antibiotics were evaluated. A total of 18 Murciano-Granadina goats were treated with ABZ and individually milked once a day over a 7-day period. ABZ quantification was performed by high performance liquid chromatography. The ABZ parent drug was not detected. The maximum concentration of its metabolites (ABZ sulfoxide, ABZ sulfone, and ABZ 2-aminosulfone) was reached on the 1^st day post treatment (260.0 ± 70.1 μg/kg, 112.8 ± 28.7 μg/kg, 152.0 ± 23.6 μg/kg, respectively), decreasing to lower than the maximum residue limit (MRL, 100 μg/kg) on the 3^rd day post treatment. Milk samples were also analyzed by microbial tests [Brilliant Black Reduction Test (BRT) MRL, Delvotest SP-NT MCS and Eclipse 100], and only one positive result was found for Delvotest SP-NT MCS and Eclipse 100. However, a high occurrence of positive outcomes was obtained for BRT MRL during 6 days post treatment, whereas ABZ residues were not detected from the 4^th day post administration, suggesting that factors other than the antiparasitic agent might affect the microbial test response.     

Reliability of selected tests from the neurobehavioral evaluation system.

NES is a widely used battery of tests designed for use in occupational health studies. Despite its widespread use, information on the reliability of the tests is limited. This article reviews the importance of test reliability and presents the results of analyses which were undertaken to examine the reliability of 11 tests and a mood rating scale contained in the NES. The NES tests were administered to 66 subjects on two testing days separated by a minimum of seven days. Seven tests were administered twice on each test day with a 3-hour interval between testing, and four of the tests were presented only once each test day. Test reliabilities were estimated for various summary measures for each test. Suggestions are made on the appropriate selection of tests and use of these.     

Sensitivity of over-the-counter pregnancy tests: comparison of utility and marketing messages.

OBJECTIVE: To determine the sensitivity of seven over-the-counter pregnancy tests (OTC-PTs) using urine containing a mixture of human chorionic gonadotropin (hCG)-related molecules as found on the first day of missed menstrual period. DESIGN: Blinded in vitro sensitivity analysis. SETTING: Medical school laboratory. PARTICIPANTS: None. INTERVENTIONS: Urine was tested with OTC-PT devices at titers of 100, 50, 25, 12.5, 6.3, and 0 mIU/mL hCG immunoreactivity, and laboratory workers rated their confidence in the test result based on whether the test result was a clear, sharp, and unquestionable band in the test window. MAIN OUTCOME MEASURES: Analytical sensitivity, defined as the urine concentration at which all OTC-PTs tested gave a positive result regardless of operator confidence score; clinical sensitivity of OTC-PTs, defined as the proportion of pregnancies likely to be detected on the first day of a missed period and calculated from the analytical sensitivity and a recently published regression curve for total urine hCG immunoreactivity in 25 urine samples from this period of gestation; percentage of tested devices showing a band in the test window at a specific hCG concentration measured devices positive; percentage faulty devices, defined as the proportion of tested devices failing to yield a band in the control window; and confidence score, determined from operator ratings for each device at each concentration of hCG. RESULTS: First Response Early Result had an analytical sensitivity of 6.3 mIU/mL, which was estimated to detect greater than 95% of pregnancies on the day of missed period. The sensitivity of Clearblue Easy Earliest Results was 25 mIU/mL, which indicated detection of 80% of pregnancies. The sensitivity of the five other products was 100 mIU/mL or greater, indicating detection of 16% or less of pregnancies. Three of these last products included faulty devices. CONCLUSION: Universal claims for OTC-PTs of more than 99% laboratory accuracy and use as early as the first day of missed period, while cleared for use by the U.S. Food and Drug Administration, are ambiguous and inappropriate for many products, according to these data. The majority of products tested were found to detect only a small percentage of pregnancies on the first day of a missed menstrual period. Until more data become available on the actual clinical sensitivity of these products, pharmacists should advise consumers to be cautious in interpreting test results.     

奥美拉唑与雷尼替丁治疗消化性溃疡急性大出血的比较

消化性溃疡急性大出血６４例，分为２组。奥美拉唑组３２例（男性２６例，女性６例，年龄４６±ｓ１７ａ），剂量４０ｍｇ，ｉｖ，ｑ１２ｈ，连用３ｄ。雷尼替丁组３２例（男性２５例，女性７例，年龄４７±１６ａ），剂量１００ｍｇ，加入５％葡萄糖溶液１００ｍＬ中，静脉滴注，ｑ１２ｈ，连用３－５ｄ。如出血停止转入抗消化性溃疡的常规治疗。２组比较，奥美拉唑止血效果明显，住院无数缩短，粪隐血转阴也快（Ｐ各＜０．０５，０．０１和０．０１）。     

阿莫西林-舒巴坦致老年患者急性间质性肾炎2例

2例老年女性患者（年龄80、74岁）分别因慢性支气管炎急性发作和皮肤感染给予阿莫西林-舒巴坦6.0 g加入0.9℅氯化钠注射液250 mL,1次/d静脉滴注。例1于次日出现尿频、尿痛、排尿困难,肉眼血尿2,4 h尿量约400 mL;实验室检查示尿蛋白（＋）,隐血（＋＋＋）;BUN 8.48 mmol/L,SCr 380μmol/L。停用阿莫西林-舒巴坦,改为林可霉素,并给予保护肾功能及对症支持治疗。15 d后24 h尿量1 500 mL,BUN 5.86 mmol/L,SCr 116μmol/L,尿常规正常。例2在药物输注完毕后即出现恶心、呕吐、腰痛、血尿;尿蛋白（＋＋＋）,隐血（＋＋）。停用阿莫西林-舒巴坦,改用林可霉素。症状无好转2,4 h尿量不足200 mL,BUN 11.45 mmol/L,SCr 467μmol/L。行血液透析,林可霉素继续使用,并给予支持及对症治疗。治疗10 d后尿量逐渐增加,22 d后24 h尿量1 200 mL,BUN 7.83 mmol/L,SCr 141μmol/L,尿常规恢复正常。     

As tests evolve and costs of cancer care rise: reappraising stool-based screening for colorectal neoplasia

Background Colorectal cancer screening and treatment are rapidly evolving. Aims To reappraise stool‐based colorectal cancer screening in light of changing test performance characteristics, lower test cost and increasing colorectal cancer care costs. Methods Using a Markov model, we compared faecal DNA testing every 3 years, annual faecal occult blood testing or immunochemical testing, and colonoscopy every 10 years. Results In the base case, faecal occult blood testing and faecal immunochemical testing gained life‐years/person and cost less than no screening. Faecal DNA testing version 1.1 at $300 (the current PreGen Plus test) gained 5323 life‐years/100 000 persons at $16 900/life‐year gained and faecal DNA testing version 2 (enhanced test) gained 5795 life‐years/100 000 persons at $15 700/life‐year gained vs. no screening. In the base case and most sensitivity analyses, faecal occult blood testing and faecal immunochemical testing were preferred to faecal DNA testing. Faecal DNA testing version 2 cost $100 000/life‐year gained vs. faecal immunochemical testing when per‐cycle adherence with faecal immunochemical testing was 22%. Faecal immunochemical testing with excellent adherence was superior to colonoscopy every 10 years. Conclusions As novel biological therapies increase colorectal cancer treatment costs, faecal occult blood testing and faecal immunochemical testing could become cost‐saving. The cost‐effectiveness of faecal DNA testing compared with no screening has improved, but faecal occult blood testing and faecal immunochemical testing are preferred to faecal DNA testing when patient adherence is high. Faecal immunochemical testing may be comparable to colonoscopy every 10 years in persons adhering to yearly testing.     

阿昔洛韦过量致急性肾衰竭

例19岁男性传染性单核细胞增多症患者拟给予阿昔洛韦600 mg加入10%葡萄糖注射液250 ml中静脉滴注.但因用药错误将阿昔洛韦3.0 g加入10%葡萄糖注射液250 ml中静脉滴注.输注完毕后9 h,患者出现明显腰痛,尿量减少,尿蛋白(+ +),尿潜血(+ +).随后出现24 h无尿.第3天肾功能检查:血清肌酐557 μmol/L,尿素9.2 mmol/L.肾脏超声示双肾弥漫性病变.行血液净化,并给予甲泼尼龙40 mg/d静脉滴注,治疗2 d.肾功能逐渐好转,尿量增多.第15天患者肾功能及尿常规检查均无异常,痊愈出院.