A new method of conduction system staining

Visualization of the conduction bundle is advantageous in the prevention of surgical trauma to the conduction system during open-heart surgery. Because vital staining using an iodine starch complex has been known to result in tissue damage, we have evaluated the effects of iodine gas on the specialized conduction system. The conduction bundle was stained, well enough to be identified, with iodine tincture, with Lugol's solution, and with iodine gas. However, all these agents except for iodine gas caused marked electrophysiological changes. Similar changes occurred with the use of ethanol and of 10% potassium iodine solution, which are the solvents of iodine tincture and Lugol's solution, respectively. Microscopic examination showed that iodine tincture, Lugol's solution, and their solvents caused marked histological changes in the conduction tissue. However, no significant changes in the conduction tissue were noted from iodine gas spraying. Therefore, tissue damage caused by iodine tincture and Lugol's solution was thought to be due not to a reaction to the iodine starch complex itself, but to their solvents. In a long-term experimental study of 10 dogs, we found that iodine gas caused no electrophysiological disturbances or damage of microscopic tissue. Of the agents we tested, only iodine gas is free from harmful effects and can be used clinically.     

Sensitivity of the thyroid and parathyroid glands to radiation

Iodine-125 seeds selectively inhibited thyroid compared with parathyroid function. Stimulation of thyroid tissue by TSH and suppression of thyroid tissue by thyroxine did not alter the sensitivity of thyroid tissue to radiation, since serum TSH concentrations were not different in the thyroxine-suppressed, control, or TSH-stimulated animals 9 weeks after discontinuing the radiation. TSH stimulation by the low iodine diet and TSH suppression by exogenous thyroxine did alter the function of the parafollicular C cells of the thyroid, since serum calcitonin concentrations were increased in the former and decreased in the latter. Serum calcium concentrations were also increased in the rats receiving the low iodine diet, but the reason for this increase is not known.     

Thyroid hormone metabolism in pediatric cardiac patients treated by continuous povidone–iodine irrigation for deep sternal wound infection

Objective: The purpose of this study was to assess the influence of povidone–iodine mediastinal irrigation used for the treatment of deep sternal wound infection (DSWI) on thyroid function. Methods: Thyroid function was studied in 18 pediatric cardiac patients treated with continuous povidone–iodine irrigation for DSWI. The median age of patients was 8 months (18 days–5.3 years). Serum concentrations of total triiodothyronine (TT3), total thyroxine (TT4), free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), reverse triiodothyronine (rT3) and thyroxine-binding globulin (TBG) were measured at three time points: (a) prior to mediastinal reexploration (before povidone–iodine exposure); (b) immediately after discontinuation of povidone–iodine irrigation; (c) 2 weeks after discontinuation of mediastinal irrigation. Urinary iodine excretion was examined on the last day of povidone–iodine exposure. Results: Prior to the mediastinal reexploration, the median TT3 and TT4 levels were below the normal range, then increased significantly to concentrations within the normal range. The median serum FT3 levels were within the normal range throughout the observation period, though a significant increase of FT3 levels was observed after discontinuation of irrigation. The median serum FT4 concentrations were within the normal range prior to irrigation and did not change significantly. The median rT3 levels were within the normal range, close to upper normal limit. The median TBG levels were within the normal range throughout the observation period, though a significant increase of TBG levels was observed during the period of mediastinal irrigation. The median TSH level was within the normal range prior to mediastinal irrigation and did not change significantly. Urinary iodine concentrations in infants with povidone–iodine irrigation were significantly higher 6700 μg/l (range, 1600–15 000 μg/l) than in the group of 53 healthy infants 200 μg/l (range, 20–780 μg/l, P<0,001). Conclusions: Our data showed that the use of povidone–iodine irrigation in the patients with DSWI has not lead to any significant alteration in thyroid function within the study period.     

Iodine deficiency produces hypercalcemia and hypercalcitonemia in rats

To determine the effect of thyroid-stimulating hormone (TSH) on secretion of calcitonin by the thyroid, 50 male Sprague-Dawley rats were randomly separated into seven groups. The groups received different diets, medications, or operations [propylthiouracil (PTU), iodine-deficient diet, (LID), acute or chronic thyroxine treatment, sham operation (SO), hemithyroidectomy (Htx), and total thyroidectomy (Ttx)]. two weeks to six months later, serum TSH concentrations were increased in the Htx, Ttx, and LID groups when compared with SO animals. Serum calcitonin concentrations were increased in the LID- and PTU-treated groups and were decreased in animals that chronically received thyroxine. Serum calcium concentrations were increased in the LID animals, decreased in the Ttx animals, and were similar in the other groups. These findings suggest that TSH stimulates both follicular and parafollicular cells in the rat thyroid and that iodine deficiency causes hypercalcemia and hypercalcitonemia.     

Iodine retention and thyroid dysfunction in patients on hemodialysis and continuous ambulatory peritoneal dialysis

Povidone-iodine is frequently used as an antiseptic in patients on chronic dialysis. In order to determine if the use of povidone-iodine affects thyroid function in these patients, we measured serum iodine and thyroid hormone levels in dialysis patients prior to and following discontinuation of topical povidone-iodine antiseptics. Serum inorganic iodine levels were elevated initially in nearly 90% of the patients (19 on hemodialysis, 12 on continuous ambulatory peritoneal dialysis [CAPD]). Following discontinuation of povidone-iodine, iodine levels over a 3-month period decreased modestly in patients on CAPD (n = 5) and were unchanged in patients on hemodialysis (n = 5). Total and free thyroxine levels were frequently low but did not correlate with protein-bound or inorganic iodine levels and did not change after discontinuation of povidone-iodine. Thyrotropin levels correlated significantly (r = .62, P less than .01) with inorganic iodine levels in patients on hemodialysis, but not for patients on CAPD. We conclude that abnormal thyroid function tests are common in dialysis patients but are not related to iodine retention or to the routine use of topical povidone-iodine-containing antiseptics.     

Lugol's iodine: its effect on thyroid blood flow in patients with thyrotoxicosis

It has been established practice for 60 years to prepare thyrotoxic patients undergoing thyroidectomy with Lugol's iodine. However, evidence in support of its claimed benefits, namely a reduction in the vascularity and friability of the toxic thyroid gland, is scanty. We have therefore determined the effect of Lugol's iodine on thyroid blood flow, as measured by thyroid uptake of thallium-201, in nine patients with Graves' disease and one euthyroid patient. Thallium-201 uptake, as well as serum thyroxine and triiodothyronine, fell significantly after treatment with iodine. Although not correlated with thyroid function tests, thallium-201 uptake was significantly correlated with thyroid weight. These results support the contention that thyroid blood flow is reduced in thyrotoxic patients treated with Lugol's iodine.     

A model of reversible obstructive jaundice in the rat

A model of reversible, extrahepatic biliary obstruction is described. Vessel loop blockade of the biliary tree results in obstructive jaundice while removal of the exteriorized vessel loop provides internal biliary drainage without subsequent laparotomy. This technique combined with a system for chronic venous infusion and arterial blood sampling in the unrestrained rat is ideal for long-term metabolic studies of obstructive jaundice. Male Fisher 344 rats (275-350 g) underwent either the combined procedure of total biliary tract blockade and vascular access or sham operation. Mean serum bilirubin was significantly elevated (12.7 +/- 8.9 mg/dl) in the experimental group and following relief of biliary obstruction significantly dropped below 1 mg/dl in all animals except one. Concomitant changes in alkaline phosphatase, glutamate oxaloacetate transaminase, and glutamate pyruvate transaminase were seen. Experimental and control rats initially lost weight following laparotomy; however, mean body weight stabilized by the 5th postoperative day and was similar in both groups on the 10th postoperative day. This combined procedure is a simple, effective and reproducible method of obstructive jaundice.     

Corrective role of Eugenia jambolana on testicular impairment in streptozotocin‐induced diabetic male albino rat: An approach through genomic and proteomic study

The present study was conducted to explore the effect of ethyl acetate fraction of hydro‐methanolic (40 : 60) extract of seed of Eugenia jambolana on testicular impairment in diabetic rats. In this respect, biomarkers of oxidative stress, genomics and proteomics in testicular tissue were assessed. Side by side, glycated haemoglobin, serum testosterone, activities of glutamate oxaloacetate transaminase and glutamate pyruvate transaminase in serum, epididymal sperm count including reproductive organosomatic indices were evaluated. Results indicate that a significant recovery (P < 0.05) in the levels of these parameters in fraction‐treated diabetic group in comparison with diabetic control. A significant recovery was noted (P < 0.05) in the expression of Bax and Bcl‐2 gene towards the control after the treatment of said fraction. Histological study also focused a significant recovery (P < 0.05) in the number of different generation of germ cells at stage VII of spermatogenesis in fraction‐treated diabetic group. The said fraction treatment to diabetic rat can recover the activities of serum glutamate oxaloacetate transaminase and glutamate pyruvate transaminase significantly towards the control (P < 0.05). Finally, it may be concluded that ethyl acetate fraction of seed of E. jambolana has a promiseable remedial effect on diabetes‐induced testicular dysfunctions in male rat without inducing any metabolic toxicity.     

Serum lipid peroxide levels of patients suffering from thermal injury

Lipid peroxide levels and activities of various enzymes were examined in sera from five thermally injured patients. In all patients examined, serum lipid peroxide levels were increased in the early post-burn period, and thereafter activities of glutamate oxalacetate transaminase, glutamate pyruvate transaminase, alkaline phosphatase and lactate dehydrogenase in the sera became elevated in most patients. From these observations, it is considered that increased lipid peroxides in the bloodstream during the early post-burn period would cause damage to various organs, permitting the leakage of the enzymes into the blood. These results support the view that lipid peroxide may be regarded as a 'burn toxin'.     

Kashin-Beck disease and iodine deficiency in Tibet

We evaluated iodine and selenium status in 575 children between 5 and 15 years with Kashin-Beck disease from endemic and non-endemic areas. Of these 267 (46%) children had goiter. The proportion of subjects with goiter was higher in the villages with Kashin-Beck disease than in the control village. In the villages with Kashin-Beck disease, 105 (23%) of the subjects had a serum thyrotropin greater than 10 mU/l as compared with 3 (4%) in the control village. The percentages of low serum thyroxine values and low serum tri-iodothyronine were greater in the villages where Kashin-Beck disease was endemic than in the control village. The percentages of low urinary iodine concentration were significantly greater in the subjects with Kashin-Beck disease. The results suggest that in areas where severe selenium deficiency is endemic, iodine deficiency is a risk factor for Kashin-Beck disease.     

Hyperthermia and metabolic acidosis during subtotal thyroidectomy for a patient with Basedow's disease

A 32-year-old man underwent subtotal thyroidectomy for Basedow's disease under general anesthesia. Preoperatively, the free thyroxine (fT4) and free triiodothyronine (fT3) levels were suppressed and thyroid stimulating hormone level was elevated with administration of iodine and propylthiouracil. Heart rate was 52 beats x min(-1) in sinus rhythm. General anesthesia was induced with fentanyl, propofol and vecuronium, and maintained with nitrous oxide, oxygen and sevoflurane. Systolic blood pressure was controlled within 100 and 130 mmHg. Rectal temperature was 36.5 degrees C after anesthesia induction, gradually rising at a range of 0.4 and 0.7 degrees C per hour, up to 38.6 degrees C four hours after the operation. Arterial blood gas showed bicarbonate 17.1 mEq x l(-1) and base excess -8.1 mmol x l(-1). The metabolic acidosis with normal anion gap lasted during and after the operation. We cooled his body with cold acetyl linger fluid and cooling mattress, and administered sodium bicarbonate. Heart rate increased to 96 beats x min(-1) before the end of operation. Subtotal thyroidectomy was finished in 5 hours 16 minutes. The amount of blood loss was 950 ml. Postoperatively, the serum fT4 and fT3 were suppressed. The serum creatine kinase and lactate dehydrogenase levels increased slightly. He did not show muscle rigidity and neurological disorders. We suspect that he has developed thyroid storm-like symptoms such as hyperthermia and tachycardia induced by subtotal thyroidectomy. Metabolic acidosis might be the result of distal tubular acidosis, which rarely accompanies Basedow's disease. Arterial blood gas analysis and urinalysis should be performed, preoperatively.     

The influence of non-steroidal anti-inflammatory and antithyroid agents on myeloperoxidase-catalysed activities of human leucocytes.

Viable leucocytes obtained fresh from normal human subjects were shown to be able to catalyse the in vitro iodination of bovine serum albumin (BSA) in a H2O2-generating system. The rate and degree of iodination were greatly improved by sonication of the cells. A balanced salt solution was a more favourable medium than phosphate buffer for the myeloperoxidase (MPO)-catalysed iodination of whole cells and sonicated cells. Reactions known to be catalysed by other peroxidases (e.g. thyroid peroxidase (TPO) and lactoperoxidase), such as inorganic iodide exchange for organic iodine in di-iodotyrosine (DIT) and the de-iodination of thyroxine (T4), were also catalysed by the sonicated leucocyte suspension in the system used. The non-steroidal anti-inflammatory drugs indomethacin, flufenamic acid and naproxen were far less effective inhibitors of MPO-catalysed BSA iodination of sonicated leucocytes at concentrations expected in blood with therapeutic dose levels than was observed earlier with TPO-catalysed in vitro iodination of BSA. The antithyroid drug methylmercapto-imidazole (MMI) inhibited in vitro MPO-catalysed 131I delabelling of 131I-DIT at all concentrations between 10(-7) and 10(-2)M, whereas 131I-T4 delabelling was markedly stimulated at the same drug concentrations. On the other hand, 125I incorporation into 131I-DIT was not affected by increased concentrations of MMI up to 10(-5)M. At higher drug concentrations the drug caused inhibition of MPO-catalysed exchange of inorganic iodide for organic iodine in DIT.     

Treatment of osteomyelitis with PVP-iodine solution using lavage-suction drainage

PVP-iodine was applied in this pilot study as irrigation solution containing 0.2% active ingredient for irrigation-suction drainage. It was well tolerated. The degree of iodine absorption remained within a lower region encountered with commonly available iodine-containing medications. Increased iodine levels returned to normal ranges soon after termination of treatment. Changes in thyroxine values were without clinical symptoms. No hypothyreosis was encountered. In spite of this it is recommended to control thyroid function before, during and after irrigation treatment with PVP-I in patients with a possible disposition for iodine-induction of thyroid function. Pregnancy (after the third month) and the presence of autonomous adenomas of the thyroid are contraindications because of the iodine load encountered. Palpable evidence for a thyroid enlargement is also a contraindication, except when the patient had not responded with thyroidal side reactions after prior exposure to iodine-containing contrast agents. During the irrigation treatment with PVP-I wounds became free of microorganisms. Local irritations due to the application of PVP-I were rare. The patient acceptance was excellent or good.     

Topical application of povidone‐iodine before wound closure is associated with significant increase in serum iodine level

Aim: To determine serum iodine level before and after local application of povidone‐iodine before wound closure in cardiac surgery patients. Povidone‐iodine is a popular antiseptic solution that has been widely used in perioperative wound management of surgical patients. Despite its widespread usage, little is known concerning the absorption profile and potential systemic toxicity. Methods: We carried out a prospective study on the serum iodine level and corresponding renal function in consecutive patients operated on at our cardiac surgical unit. Results: There was a statistically significant increase in serum iodine level and patients with impaired renal function defined by creatinine level showed significantly higher postoperative iodine levels. Conclusion: Systemic iodine absorption is evidence that, even with single wound irrigation, repeated usage should be avoided in patients with renal impairment.     

Changes in plasma free thyroid hormones during cardiopulmonary bypass do not indicate triiodothyronine substitution.

Concentrations of free and bound thyroid hormone in plasma during cardiopulmonary bypass were determined in 10 patients. Ages ranged from 50 to 76 years (median 61 years). Apart from thyroxine and triiodothyronine, a number of other variables that might contribute to an altered thyroid state or binding of thyroxine and triiodothyronine to plasma proteins were measured (thyroid stimulating hormone, reverse triiodothyronine, albumin, nonesterified fatty acids, and cortisol). At the end of the observation, total triiodothyronine and total thyroxine concentrations were 86% and 70% (mean) of initial levels, respectively, and reverse triiodothyronine and albumin concentrations were both 74%. On the contrary, free triiodothyronine and free thyroxine levels rose to a maximum of 137% and 203% (mean), but normalized after heparin neutralization (86% and 102%). Thyroid-stimulating hormone concentration declined insignificantly during cardiopulmonary bypass, reaching a minimum at the time when body temperature was maximally depressed (74%), and then it normalized (101%). Plasma cortisol level did not rise above normal limits despite the major stress stimulus. In conclusion, total triiodothyronine and total T4 concentration in plasma of patients undergoing cardiac operations is lowered, while the exchangeable pool concentrations (plasma free triiodothyronine and free thyroxine) are elevated during bypass but return to control levels at the end of the operation. If serum changes truly reflect intracellular events, it does not seem likely that the myocardial cell is depleted of thyroid hormones after cardiopulmonary bypass, as recently claimed by others. This finding does not, however, exclude the possibility that a pharmacologic dose of triiodothyronine may be convenient for improvement of cardiac performance.     

窄带成像与碘染色在早期食管癌内镜黏膜下剥离术中的应用比较

目的比较窄带成像（NBI）与碘染色在早期食管癌内镜黏膜下剥离术（ESD）治疗中的临床价值。方法回顾性分析2010年9月至2011年8月间接受ESD治疗的87例早期食管癌（包括高级别上皮内瘤变）患者的临床资料,其中术前经NBI法确定病变边界者37例（NBI组）,采用碘染色法确定病变边界者50例（碘染色组）。比较两组患者ESD术中食管痉挛程度、手术时间、完整切除率、并发症发生率以及术后复发等情况。结果两组患者病变部位、大小和周径的差异均无统计学意义。NBI组中重度食管痉挛者的比例为10．8％（4／37）,明显低于碘染色组的比例[32．0％（16／50）,P〈0．05];手术时间亦明显短于碘染色组[（42．2±19．5）min比（53．3±30．9）rain,P〈0．05]。NBI组术中穿孔1例,术后迟发性出血1例;碘染色组术中穿孔1例,均经内镜下处理及保守治疗治愈。术后随访4～20月,NBI组与碘染色组患者术后食管狭窄[8．1％（3／37）比8．0％（4／50）]和局部复发[5．4％（2／37）比4．0％（2／50）]发生率的差异均无统计学意义（均P〉0．05）。结论与碘染色相比,早期食管癌ESD术前采用NBI确定病变边界,可在不影响疗效的基础上减轻食管痉挛并缩短手术时间。     

Comparison of three Glasgow multifactor prognostic scoring systems in acute pancreatitis

Modifications have been proposed in an attempt to improve the clinical value of the original nine-factor Glasgow prognostic scoring system for acute pancreatitis. These include the omission of age or serum transaminase, reducing the factors to eight. Debate exists as to which system should be employed. Assessment of the individual factors in 198 attacks of acute pancreatitis treated conventionally revealed that only serum transaminase did not differ significantly between mild and severe outcome groups. Multivariate analysis demonstrated four factors (Pa,O2, white cell count, lactic dehydrogenase, and urea) with independent significance in predicting severity, while serum glucose, albumin and transaminase were least useful. Findings were similar when considering only patients with gallstone aetiology. The reduction of the prognostic factors to eight by the omission of either age or transaminase improved the predictive value of the scoring system, both when considering all attacks and those of gallstone aetiology alone. We suggest that serum transaminase should be omitted because: it shows no significant difference between mild and severe outcome groups, while age has prognostic significance; the system has greater sensitivity than if age is omitted; and the number of factors requiring emergency laboratory measurement for immediate prognostication is reduced by one.     

Safety evaluation of long-term vas occlusion with styrene maleic anhydride and its non-invasive reversal on accessory reproductive organs in langurs

Aim: To evaluate the safety of the long term vas occlusion with styrene maleic anhydride (SMA) and its non-invasive reversal at the level of accessory reproductive glands (ARGs) in langurs. Methods: The morphology of seminal vesicle and ventral prostate was evaluated by light as well as transmission electron microscopy. Serum clinical chemistry and urine albumin were evaluated in an autoanalyzer using reagent kits. Fructose, acid phosphatase and zinc in the seminal plasma were evaluated spectrophotometrically according to the WHO manual. Serum testosterone,prostate specific antigen and sperm antibodies were evaluated by enzyme-linked immunosorbent assays (ELISA) using reagent kits and hematology was estimated according to standard procedures. Results: The morphological features and secretory activity of the seminal vesicle and prostate were normal as evidenced by the presence of well-developed mitochondria, rough endoplasmic reticulum, Golgi bodies, secretory granules and normal nuclear characteristics throughout the course of investigation. Serum testosterone and prostate specific antigen remained unaltered and serum antisperm antibodies level presented negative titres. Urine albumin was nil. Total red blood corpuscles (RBC), white blood corpuscles (WBC), hemoglobin (Hb) and red cell indices, serum protein, glucose, cholesterol,creatinine, creatine kinase (CK), serum glutamate oxalate transaminase (SGOT), serum glutamate pyruvate transaminase (SGPT), lactate dehydrogenase (LDH), bilirubin, urea, triglycerides and high-density lipoprotein (HDL) did not show appreciable changes following vas occlusion and after its non-invasive reversal. Although fructose, acid phosphatase (ACP) and zinc in the seminal plasma showed a significant reduction following vas occlusion, it could not be related to the morphology of seminal vesicle and prostate. Conclusion: SMA vas occlusion and its non-invasive reversal do not damage the accessory reproductive organs.     

直肠上动脉插管注射美蓝染色在直肠癌根治术中的应用

目的探讨直肠上动脉插管注射美蓝对直肠癌根治术中全直肠系膜切除(TME)的指示作用及淋巴结染色后清除数的变化. 方法对我科2002年1月～2003年12月行直肠癌手术的53例病人,随机选择25例术中经直肠上动脉插管注射美蓝6 ml,另28例行普通根治,观察淋巴结清除情况. 结果注射美蓝组患者直肠系膜染色良好,骶前间隙界限清楚,无输尿管损伤及骶前静脉丛损伤,淋巴结检出数明显高于对照组(P<0.05). 结论直肠癌术中经直肠上动脉插管注射美蓝能清楚显示直肠系膜,避免输尿管和骶前静脉丛的损伤,同时能提高系膜淋巴结检出数,便于病理分期.     

Iodine resorption and excretion in Betaisodona (Betadine) treatment of extensive burns

Summary Iodine resorption and excretion, glomerular filtration and blood gas ratings in three patients with extensive burns during Betaisodona (Betadine) treatment were examined. The serum-iodine level increased up to 7 mg% as did the urine iodine content. The creatinine in the urine increased up to 100% but serum levels remained normal as did the pH and blood-gas analyses. No signs of iodine-intoxication or acidosis were found. Careful observation of the iodine-glomerular filtration pH and blood gas parameters is recommended, especially in children when Betaisodona is used in dermal burns.