The lack of a systemic inflammatory response syndrome supports the safety of pancreatic electrolysis: experimental studies

BACKGROUND: Per-ductal pancreatic electrolysis is a new minimally invasive ablation treatment. Possible applications include tumor debulking and treatment of chronic pancreatitis. Both solid organ ablation and pancreatitis are associated with the risk of an overwhelming systemic inflammatory response syndrome (SIRS) and multiorgan failure. TNF-alpha and IL1-beta are important cytokine mediators of this response. The aim of this study was to measure the circulating levels of IL1-beta and TNF-alpha following pancreatic electrolytic ablation as a marker of the risk of SIRS complicating per-ductal pancreatic electrolysis. METHODS: Serum TNF-alpha and IL1-beta were measured in six treatment and six control pigs before and after laparotomy and pancreatic electrolytic ablation via a per-ductal approach. RESULTS: There was no significant rise in serum TNF-alpha and IL1-beta in association with per-ductal pancreatic electrolysis. CONCLUSIONS: This study supports the evidence that per-ductal electrolysis is a safe procedure with potential for palliative treatment of pancreatic cancers.     

Electrolytic liver ablation is not associated with evidence of a systemic inflammatory response syndrome

BACKGROUND: Local ablation has been proposed for treatment of liver tumours. Cryoshock, a variant of the systemic inflammatory response syndrome (SIRS), is a potentially fatal complication of cryoablation caused by systemic release of necrotic breakdown products from ablated liver. The proinflammatory cytokines tissue necrosis factor (TNF) alpha and interleukin (IL) 1 are important mediators of this response. This study assessed the risk of SIRS complicating electrolytic liver ablation by measuring circulating levels of inflammatory cytokines, other inflammatory markers and clinical markers of organ function. METHODS: Electrolytic liver ablation was performed in 16 pigs and four pigs served as controls. Platelet count, and serum levels of urea, creatinine, liver enzymes, C-reactive protein (CRP), TNF-alpha and IL-1beta were measured before treatment and for 72 h after the procedure. RESULTS: There were significant dose-related increases in CRP and alanine aminotransferase levels with liver electrolysis. There was no significant derangement in renal function or platelet count following ablation. A rise in serum TNF-alpha and IL-1beta levels was not associated with liver electrolysis. CONCLUSION: There was no evidence of organ failure or significantly raised levels of proinflammatory cytokines as a result of liver electrolysis, suggesting that this is a safe procedure for liver ablation.     

Comparison of Alexandrite Laser and Electrolysis for Hair Removal

BACKGROUND: Different techniques have been used for hair removal. Electrolytic epilation is a widely accepted method for this purpose. Recently laser hair removal was introduced. OBJECTIVE: To evaluate and compare the effectiveness of long-pulse alexandrite laser hair removal with electrolytic epilation. METHODS: Twenty-four areas of unwanted axillar hair in 12 patients were included in the study. The right axillar area of the patients was treated by electrolysis with an intensity of 4-8 mA, and the left area was treated with long-pulse alexandrite laser with fluences between 30 and 50 J/cm2. Electrolysis was performed four times at 3-week intervals, and laser treatment was performed three times at 4-week intervals. Before each session, the hairs in a 4 cm2 area centered in the axilla were counted. The last evaluation was done 6 months after the initial treatment. The pain, time, and cost of each procedure are compared. RESULTS: The average clearance rate of the hairs was 74% by laser and 35% by electrolysis 6 months after the initial treatment. CONCLUSION: Alexandrite laser hair removal is a more reliable and practical solution than electrolysis. Laser hair removal is more expensive than electrolysis, but is 60 times faster and less painful than electrolysis; also fewer sessions are needed with the laser with better results.     

Systematic reaction to electrolytic treatment of pig livers in vivo

BACKGROUND: Only a minority of secondary liver tumours are amenable to segmental resection and as a result, considerable research has been focused on developing ablative methods to destroy liver metastases. Many of these methods are limited by the development of a systemic inflammatory response mediated by cytokines such as interleukin-8 (IL-8) and tumour necrosis factor alpha (TNF-alpha). The aim of the present study was to determine if a systemic reaction occurred following electrolytic treatment of pig livers in vivo, by measuring biochemical indices of liver function and cytokines such as IL-8 and TNF-alpha. METHODS: Seventeen white domestic pigs were subjected to varying electrolytic doses ranging from 100 C to 800 C. Blood samples were taken at hourly intervals before, during and after electrolysis. Blood parameters measured included markers of liver enzyme activity; albumin, alkaline phosphatase, gammaglutaryl transferase and aspartate transaminase. Cytokine response to electrolysis was measured using enzyme-linked immunosorbent assays for IL-8 and TNF-alpha. RESULTS: Aspartate transaminase levels showed a clear and progressive rise post-electrolysis peaking at 2 h post-procedure. IL-8 and TNF-alpha levels showed only very mild variation with no significant response to electrolysis. This lack of association was borne out regardless of the electrolytic dose administered. CONCLUSION: Electrolysis is not accompanied by a significant systemic inflammatory response, reducing the risk of systemic inflammatory response, acute respiratory distress syndrome and other immune response mediated end-organ damage. Follow-up studies are needed in human trials.     

Double-masked trial of fenoprofen sodium: treatment of chronic aphakic cystoid macular edema

Aphakic cystoid macular edema is a serious eye disease. Its etiology is unknown, but a widely held theory attributes it to an inflammatory response to surgical trauma. In a double-masked study, a 1% solution of fenoprofen sodium, a topically applied antiprostaglandin agent, was evaluated against placebo in determining the effectiveness of fenoprofen in the treatment of chronic aphakic cystoid macular edema. Fourteen patients, five women and nine men, participated in the study. Fenoprofen sodium was found to have no effect on the course of chronic aphakic cystoid macular edema. We believe that the lack of effect may have been due to the duration of edema at the time of treatment or to the small sample size. Larger studies in the immediate postoperative period are suggested. The importance of iris angiography as a possible predicting technique of macular leakage is emphasized.     

The use of a "liquid" electrode in hepatic electrolysis

BACKGROUND: The use of direct current electrolysis as a local nonthermal ablative technique for colorectal liver metastases promises to be a simple, safe, and effective therapy. Under general anesthesia, electrolysis is presently limited to tumors smaller than 5 cm, due to the protracted nature of its administration. In an attempt to enhance the effect of electrolysis, a direct current was passed through a preinjected bolus of acetic acid. METHODS: The effect of a combination of electrolysis and an injection of acetic acid was tested in the liver of eight normal pigs. The volumes of necrosis caused were analyzed. RESULTS: Acetic acid independently produced a volume of necrosis but did not provide a volumetric or rate advantage when used in combination with a direct current. Statistically, the only main effect on the volume of necrosis was a result of electrolysis. CONCLUSION: The use of 50% acetic acid to augment the efficacy of direct current electrolysis cannot be recommended.     

Interstitial inflammation,sodium retention,and the pathogenesis of nephrotic edema: a unifying hypothesis

BACKGROUND: The pathophysiology of edema in the nephrotic syndrome is controversial. Some investigators believe that sodium retention may result from a primary renal defect that causes an "overfilled" blood volume. In contrast, other authors believe that fluid escapes the vascular compartment due a low oncotic pressure, and sodium retention is a compensatory physiological response to an "underfilled" blood volume. The patients that best fit the "underfilled" hypothesis are children with minimal-change nephrotic syndrome (MCNS). METHODS: We analyzed critically the available evidence for and against each proposed pathogenic mechanism in the light of recent evidence indicating that the inflammatory infiltrate may play a role in primary renal sodium retention. RESULTS: Inflammatory infiltrate in the kidney is a constant characteristic in nephrotic syndrome associated with primary sodium retention and it is absent in most cases of MCNS in children CONCLUSIONS: We propose that primary sodium retention in the nephrotic syndrome depends on the existence and the intensity of renal inflammatory infiltrate, conspicuously absent in most cases of MCNS in children and present in other conditions associated with massive proteinuria. The tubulointerstitial inflammatory infiltrate is associated with increased vasoconstrictive mediators that result in increased tubular sodium reabsorption and with glomerular hemodynamic changes that reduce filtered sodium load.     

Comparative analysis of tissue reactions to anesthetic solutions: histological analysis in subcutaneous tissue of rats

Postanesthetic pain is a relatively common complication after local anesthesia. This complication may be caused by the anesthetic technique or by the anesthetic solution used. Tissue reactions induced by the anesthetic solutions may be one of the factors resulting in pain after anesthesia. The objective of this study was to comparatively analyze tissue reactions induced by different anesthetic solutions in the subcutaneous tissue of rats. The following solutions were utilized: 2% lidocaine without vasoconstrictor; a 0.5% bupivacaine solution with 1:200,000 adrenaline; a 4% articaine solution and 2% mepivacaine, both with 1:100,000 adrenaline; and a 0.9% sodium chloride solution as a control. Sterilized absorbent paper cones packed inside polyethylene tubes were soaked in the solutions and implanted in the subcutaneous region. The sacrifice periods were 1, 2, 5, and 10 days after surgery. The specimens were prepared and stained with hematoxylin and eosin for histological analysis. The results showed that there is a difference in tissue irritability produced by the local anesthetic solutions. The results also showed that there is no relation between the concentration of the drug and the inflammatory intensity, that the mepivacaine and articaine solutions promoted less inflammatory reaction than the bupivacaine, and that the lidocaine solution produced the least intense inflammation.     

Hypertonic saline resuscitation protects against kidney injury induced by severe burns in rats

BackgroundProper fluid resuscitation can relieve visceral damage and improve survival in severely burned patients. This study compared the effectiveness of resuscitation with 400 mEq/L hypertonic saline (HS) and sodium lactate Ringer’s solution (LR) in rats with kidney injury caused by burn trauma.MethodsRats (Sprague-Dawley) underwent burn injury and were randomized into sham, LR, and HS groups. Samples from the kidney were assayed for water content ratio, histopathology, and oxidative stress (superoxide dismutase (SOD) and malondialdehyde (MDA)). Serum sodium, renal function (creatinine and cystatin (Cys)-C), and inflammatory response (tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and high mobility group protein box (HMGB)-1) were also examined as serum markers.ResultsHypertonic saline resuscitation reduced the renal water content ratio and improved renal histopathology caused by severe burns. This effect was accompanied by reductions in serum creatinine and Cys-C as well as TNF-α, IL-1β, and HMGB1. Serum sodium concentration and SOD activity were increased, whereas MDA content was decreased in the kidney tissue of the HS group.ConclusionsThe data indicate that 400 mEq/L HS solution reduces hyponatremia and renal edema, inhibits the release of inflammatory mediators, and alleviates oxidative stress injury, thus protecting against kidney injury induced by severe burns.     

In-vitro studies of gallstone dissolution: the effect of added heparin in bile salt solutions.

The dissolving effect of four bile salt solutions (sodium cholate, sodium taurocholate, sodium deoxycholate and sodium chenodeoxycholate) upon gallstones was tested in an in-vitro preparation, using 226 stones from 38 patients. The effect of each solution was measured by recording weight loss in the gallstone at the end of a ten-day period of immersion in the bile salt solution. Sodium deoxycholate and sodium chenodeoxycholate produced the greatest average weight loss in the groups of stones tested with pure bile salt solutions, but the addition of heparin to solutions of sodium cholate and sodium deoxycholate produced a significant increase in weight loss in these solutions. This effect of heparin in the presence of bile salts, in comparison with the failure of heparinized saline to induce weight loss in gallstones, is discussed. Sodium chenodeoxycholate cannot be recommended for clinical use on the grounds of its toxicity, and in view of the possible toxicity of sodium deoxycholate it is concluded that a combination of sodium cholate with heparin is the optimum solution for the dissolution of retained intraduct calculi in vivo.     

Mixture of hyaluronic acid and phospholipid prevents adhesion formation on the injured flexor tendon in rabbits.

Dipalmitoyl phosphatidylcholine, a highly surface-active polar lipid, has been implicated as a potential boundary lubricant for synovial joints. We examined the effects of dipalmitoyl phosphatidylcholine on the flexor tendon and its protective effect against postoperative adhesion in two experimental steps. First, the flexor digitorum fibularis and the distal pulley of rabbits were set for a friction test. The test was performed with saline solution, sodium hyaluronate, or a mixture of dipalmitoyl phosphatidylcholine and sodium hyaluronate as the lubricant. The friction coefficient was significantly lower with the mixture of dipalmitoyl phosphatidylcholine and sodium hyaluronate than with saline solution or sodium hyaluronate. We concluded that the decreased friction coefficient indicates that dipalmitoyl phosphatidylcholine could complement the boundary-lubricating ability of the tendon. In the second experiment, we used an experimental adhesion model of the flexor digitorum fibularis in the rabbit. During the operation, either saline solution, sodium hyaluronate, or a mixture of dipalmitoyl phosphatidylcholine and sodium hyaluronate was injected into the tendon sheath. The specimen was sent to another tester, and the work required to tear off the adhesion was measured. The work required was significantly greater for the tendons that had been injected with saline solution than for those given injections of dipalmitoyl phosphatidylcholine and sodium hyaluronate. Our findings suggest that dipalmitoyl phosphatidylcholine plays an important role in the boundary lubrication of the tendon and that after tendon injury, the administration of a mixture of dipalmitoyl phosphatidylcholine and sodium hyaluronate may improve tendon lubrication and prevent adhesion formation.     

Postoperative water and electrolyte changes in skeletal muscle: a clinical study with three different intravenous infusions

Twenty-seven patients admitted for cholecystectomy were matched for age and sex in three groups for different perioperative fluid therapies over a period of 3 days. Group I was given an acetated half-isotone "balanced" saline solution with the addition of 2.5% glucose, Group II an acetated Ringer solution and Group III an isotonic glucose solution. Percutaneous muscle biopsies were performed before and on the third day after surgery for the determination of water content and the concentration of sodium, potassium, magnesium and chloride in skeletal muscle. The cumulative balance of sodium and potassium was measured daily during the study. In all three groups a significant increase in the total muscle water content was demonstrated. The concentration of sodium and chloride in skeletal muscle increased significantly in Groups II and III, whereas the concentration of potassium decreased in all groups. The cumulative sodium balance was positive in Groups I and II; the potassium balance was negative in all groups. In conclusion, the patients given the balanced saline solution showed the least change in water content and electrolyte concentrations in skeletal muscle.     

3升生理氯化钠溶液袋暂时性关腹的临床应用

目的探讨腹腔严重感染病人应用3升生理氯化钠溶液袋暂时性关腹技术的价值。方法回顾性分析2007年9月至2009年1月间7例严重腹腔感染应用3升生理氯化钠溶液袋暂时性关腹,观察治疗效果、预后。结果本组痊愈5例,无严重并发症出现,多器官功能衰竭死亡1例,放弃治疗1例。结论3升生理氯化钠溶液袋暂时性关腹技术是一种价格低廉、有效的特殊情况时使用的暂时性关腹手段。     

Effect of Dialysate Sodium Reduction on Body Water Volume,Blood Pressure,and Inflammatory Markers in Hemodialysis Patients — A Prospective Randomized Controlled Study

Accumulating evidence suggests an association between body volume overload and inflammation in chronic kidney diseases. The purpose of this study was to evaluate the effect of dialysate sodium concentration reduction on extracellular water volume, blood pressure (BP), and inflammatory state in hemodialysis (HD) patients. In this prospective controlled study, adult patients on HD for at least 90 days and those with C-reactive protein (CRP) levels ≥ 0.7 mg/dL were randomly allocated into two groups: group A, which included 29 patients treated with reduction of dialysate sodium concentration from 138 to 135 mEq/L; and group B, which included 23 HD patients not receiving dialysate sodium reduction (controls). Of these, 20 patients in group A and 18 in group B completed the protocol study. Inflammatory, biochemical, hematological, and nutritional markers were assessed at baseline and after 8 and 16 weeks. Baseline characteristics were not significantly different between the two groups. Group A showed a significant reduction in serum concentrations of tumor necrosis factor-α, and interleukin-6 over the study period, while the BP and extracellular water (ECW) did not change. In Group B, there were no changes in serum concentrations of inflammatory markers, BP, and ECW. Dialysate sodium reduction is associated with attenuation of the inflammatory state, without changes in the BP and ECW, suggesting inhibition of a salt-induced inflammatory response.     

IN-VITRO STUDIES OF GALLSTONE DISSOLUTION: THE EFFECT OF ADDED HEPARIN IN BILE SALT SOLUTIONS

The dissolving effect of four bile salt solutions (sodium cholate, sodium taurocholate, sodium deoxycholate and sodium chenodeoxycholate) upon gallstones was tested in an in-vitro preparation, using 226 stones from 38 patients. The effect of each solution was measured by recording weight loss in the gallstone at the end of a ten-day period of immersion in the bile salt solution. Sodium deoxycholate and sodium chenodeoxycholate produced the greatest average weight loss in the groups of stones tested with pure bile salt solutions, but the addition of heparin to solutions of sodium cholate and sodium deoxycholate produced a significant increase in weight loss in these solutions. This effect of heparin in the presence of bile salts, in comparison with the failure of heparinized saline to induce weight loss in gallstones, is discussed. Sodium chenodeoxycholate cannot be recommended for clinical use on the grounds of its toxicity, and in view of the possible toxicity of sodium deoxycholate it is concluded that a combination of sodium cholate with heparin is the optimum solution for the dissolution of retained intraduct calculi in vivo.     

The use of topical, un-buffered sodium hypochlorite in the management of burn wound infection

Background

Burn wound infections are a major cause of morbidity and mortality. The bactericidal action of sodium hypochlorite has been known for centuries and it has been in clinical practice for over 70 years. Whereas a buffered sodium hypochlorite solution is not universally available, an un-buffered solution is cheap and easy to prepare.

Aim

The aim of this study was to determine the optimum concentration with regard to safety and efficacy, as well as shelf life of an un-buffered sodium hypochlorite solution for the topical management of burn wound infections.

Methods

Human fibroblasts were exposed to serial dilutions of un-buffered sodium hypochlorite solutions for 30 min and assessed for viability. Isolates of Pseudomonas aeruginosa, Staphylococcus aureus and Streptococcus pyogenes were exposed to the same dilutions of un-buffered sodium hypochlorite to establish the minimum bactericidal concentration. The pH, osmolality and electrolyte concentrations were measured. These experiments were repeated with solution stored at room temperature for 6 consecutive days.

Results

24% of fibroblasts were viable after exposure to a 0.025% solution and 98.9% with a 0.003% solution. The MBC for the P. aeruginosa isolates was 0.003%, for S. aureus was 0.006% and for S. pyogenes was 0.0015%. This remained constant for 6 consecutive days. The un-buffered 0.0025% solution has a pH of 10, an osmolality of 168 sodium concentration of 89 mmol/dl and chloride of 84 mmol/dl. This remained stable for 14 days.

Conclusions

An un-buffered solution of sodium hypochlorite with a concentration of 0.006% would be suitable for the topical management of burn wound infections caused by common pathogens. It has a shelf life of at least 6 days.     

4％枸橼酸钠溶液在中心静脉置管血液透析患者中的应用

目的观察4％枸橼酸钠封管液在临时性中心静脉置管血液透析患者中的应用。方法将61例维持性血液透析患者随机分为2组,即4%枸橼酸钠封管组30例,肝素钠封管组31例。每次透析结束后,对2组患者分别以4％枸橼酸钠和肝素钠封管,均连续使用5周。评价2组患者导管相关的出血、感染和导管功能不良情况。结果①4％枸橼酸钠封管组导管相关的出血事件发生率较肝素钠封管组低,差异有统计学意义（P〈0．05）。②4％枸橼酸钠封管组有1例次出现透析中发热,但导管液和血液细菌培养均为阴性,肝素钠封管组有1例患者出现透析中发热,导管液培养为金黄色葡萄球菌阳性,血培养为阴性。③2组患者导管功能不良发生率无显著差异（P〉0．05）。结论对于临时性中心静脉置管的血液透析患者,4％枸橼酸钠封管液可作为常规肝素钠封管液的替代。     

EFFECT OF DIFFERENT INTRAOPERATIVE FLUID REGIMENS ON CIRCULATING METABOLITES AND INSULIN DURING ABDOMINAL SURGERY

The effects of infusion i.v. of 0.9% sodium chloride solution,Hartmann's solution and 5% dextrose solution on the concentrationsof circulating metabolites and insulin were compared in patientsundergoing chole-cystectomy. Hartmann's solution had a similareffect on the metabolic response to 0.9% sodium chloride solution,but the use of 5% dextrose was associated with an exacerbationof the hyperglycaemic response to surgery. Plasma insulin concentrationsincreased significantly in the group receiving 5% dextrose showingthat the usual suppression of insulin during abdominal surgerycan be overcome by a strong glycaemic stimulus     

Effect of dietary sodium restriction on body water,blood pressure,and inflammation in hemodialysis patients: a prospective randomized controlled study

Purpose

Accumulating evidence suggests an association between body volume overload and inflammation in chronic kidney diseases. The purpose of this study was to evaluate the effect of dietary sodium reduction in body fluid volume, blood pressure (BP), and inflammatory state in hemodialysis (HD) patients.

Methods

In this prospective controlled study, adult patients on HD for at least 90 days and those with C-reactive protein (CRP) levels ≥0.7 mg/dl were randomly allocated into two groups: group A, which included 21 patients treated with 2 g of sodium restriction on their habitual diet; and group B, which included 18 controls. Clinical, inflammatory, biochemical, hematological, and nutritional markers were assessed at baseline and after 8 and 16 weeks.

Results

Baseline characteristics were not significantly different between the groups. Group A showed a significant reduction in serum concentrations of CRP, tumor necrosis factor-α, and interleukin-6 during the study period, while BP and extracellular water (ECW) did not change. In group B, there were no changes in serum concentrations of inflammatory markers, BP, and ECW.

Conclusions

Dietary sodium restriction is associated with the attenuation of the inflammatory state, without changes in BP and ECW, suggesting inhibition of a salt-induced inflammatory response.     

Long term changes in total body water, total exchangable sodium and total body potassium before and after ileostomy.

In 10 patients with inflammatory bowel disease, total body water, total body potassium and total exchangable sodium were measured both before and 6 months after the establishment of a permanent iseostomy. All 10 patients underwent elective surgery for their inflammatory bowel disease but all were malnourished before surgery when their body composition was first measured. Six months later, when the body composition was again determined, all the patients were in good health and had normally functioning ileostomies. As a group they had gained 6-8 kg in body weight and 372 mEq total body potassium over the 6-month period. When the 'normal' total body water was calculated for each patient, a deficit of 12-4 per cent for the group was found before surgery and this was still present (11-1 per cent) 6 months later. The concentration of exchangable sodium in the body water fell from an abnormally high level before surgery to within the normal range 6 months later. These data show that defictis in total body water occurring preoperatively are not repaired in the months following the establishment of a well-functioning ileostomy, and that a reduction of total exchangeable sodium is present in patients with an ileostomy who are otherwise well. It is suggested that these findings should encourage the surgeon managing patients with intractable inflammatory bowel disease to strive for good nutrition and normal body composition before embarking on excisional surgery and the establishment of a permanent ileostomy.