Diet,fecal bile acids,and neutral sterols in carcinoma of the colon

Increased concentrations of fecal bile acids and neutral sterols or their degradation products have been linked to certain diets and are implicated in colonic carcinogenesis. We measured fecal bile acid and neutral sterol concentrations by thin-layer and gas-liquid chromatography in 15 patients with colonic adenocarcinoma, 23 controls, and 16 patients with nongastrointestinal cancer. We compared these results with dietary intake. Detailed dietary histories showed no differences among the groups in the ingestion of calories, protein, fiber, fat, or carbohydrate. A wide variation in fecal concentration of individual bile acids and neutral sterols was found within each group, but no significant differences in the total bile acid or total neutral sterol per gram dry weight feces were found. Decreased coprostanol, coprostanone, and lithocholic acid excretion was found in the colon cancer group compared with controls. The fecal excretion of all bile acids and neutral sterols was lower significantly in the nongastrointestinal cancer patients with liver metastases as compared with those without. We conclude that total bile acid and total neutral sterol excretion is similar in the three groups, all ingesting similar diets. We cannot confirm reported increased excretion of total bile acids nor excessive bacterial conversion to degradation products in colonic cancer patients. Hepatic metastases correlate with decreased fecal excretion of both bile acids and neutral sterols, which may be due to diminished hepatobiliary excretion.     

Tumor necrosis factor alpha-induced endothelial tissue factor is located on the cell surface rather than in the subendothelial matrix

Because there is no consensus regarding the precise distribution of induced endothelial tissue factor (TF), we studied TF activity in and on tumor necrosis factor alpha-stimulated cultured human umbilical vein endothelial cells (ECs) and their underlying matrix. TF was mainly expressed on the cell surface. Only small traces were found on the apical surface suggesting that TF is predominantly located on the basolateral side of the cell membrane. The presence of TF on the cell surface was confirmed by flow cytometry. Subendothelial TF activity appeared to be dependent upon the procedure used to remove the stimulated EC monolayer. Whereas ammonium hydroxide or hypotonic lysis resulted in relatively high levels of matrix-associated TF, virtually no TF was found on the matrix after mild enzymatic detachment of stimulated ECs. Cell removal with EDTA resulted in intermediate levels of matrix-associated TF. Neither the enzymatic treatment nor EDTA degraded or removed this TF activity. Similar patterns were observed for matrix-associated TF antigen and EC surface markers. Electron microscopic analysis showed cell fragments on the matrix after monolayer lysis. The findings strongly suggest that induced endothelial TF associated with the subendothelial matrix actually represents TF on EC remnants.     

A prospective study examining balance confidence among individuals with lower limb amputation

Purpose:?In this study we assessed whether balance confidence scores changed over a 2-year follow up period, and identified predictors of balance confidence and predictors of change in balance confidence among lower limb amputees.

Method:?A prospective follow-up survey of 245 community living adults with unilateral below and above knee lower limb amputation who used their prosthetic limb daily was conducted. Balance confidence, assessed using the 16-item Activity-specific Balance Confidence (ABC) Scale, socio-demographic, health and amputation related variables were collected at baseline and 2 years later.

Results:?ABC scores were similar at baseline (mean?= 67.6; SD?=?25.7) and follow up (mean?=?68.0; SD?=?25.8). Lower balance confidence scores at follow up were predicted by older age, being female, use of a mobility device, poor perceived health, increased symptoms of depression, having to concentrate while walking, and fear of falling (all p?<?0.05). Predictors of change in balance confidence included gender and perceived health (all p?<?0.05).

Conclusion:?Balance confidence appears to be a persistent problem in the amputee population. Health professionals are encouraged to consider balance confidence as a potentially important variable that may influence function in this clinically unique group of individuals. The identified predictor variables may be useful to clinicians in targeting individuals who require attention to improve balance confidence.     

Immunological memory induced by genetically transduced tumor cells

Background: Recent studies have demonstrated the usefulness of gene-modified tumor cells for immunotherapy. Using the tumorigenic murine fibrosarcoma, MCA 106, we investigated the effects of localized interferon-γ (IFNg) secretion on tumorigenicity and on long-term memory. Methods: The murine IFNg (MuIFNg) gene was introduced into tumor cells. High and low IFNg-secreting clones were isolated. C57BL/6 mice were injected subcutaneously (s.c.) with either parental (P), high or low IFNg-secreting (H- or L-IFNg) cells, and tumor growth was assessed weekly. Spleens were harvested on different days postinjection (p.i.) to assess in vitro cytolytic activity. In parallel, tissues from injection sites were stained with macrophage-, CD4-, and CD8-detecting antibodies. Mice were injected s.c. with H-IFNg MCA106 tumor. After 150 days the animals were rechallenged s.c. with MCA106P in one leg and with irrelevant syngeneic tumor in the other. Results: Both P- and L-IFNg cells had similar growth, whereas the H-IFNg cells never grew. Only splenocytes from the H-IFNg animals showed in vitro CTL activity persisting until day 30 p.i. Histological data revealed a macrophage and CD4⁺ infiltrate much earlier in the H-IFNg group compared with the P group. Only the irrelevant, syngeneic tumor grew in animals previously injected with H-IFNg cells, whereas both P and irrelevant syngeneic tumors grew in controls. Conclusions: Transduction of MCA106 cells with the MuIFNg gene diminished in vivo tumorigenicity in proportion to the amount of IFNg secreted. Immunization with H-IFNg cells elicited a host response characterized by macrophages and CD4⁺ cells. Long-term tumor-specific memory was seen after immunization with H-IFNg cells.     

The effect of visual deprivation on canine gastric secretion

In 13 dogs with gastric cannulas the acid output per hour was determined after: (a) subcutaneous injection of 0.1 mg histamine (base), (b) subcutaneous injection of 1.0 mg histamine (base), (c) teasing with meat (10 min interval), (d) intravenous injection of 1.0 units/kg of insulin. The pepsin concentration was also determined after the intravenous injection of 1.0 units/kg of insulin. The range and average acid output and pepsin concentration were established for each test condition per dog. Vision was compromised in the dogs by ablation of the orbits, collapse of the orbits, and by occipital cortical lesions. Gastric secretory studies were repeated at intervals over a 4 month period. There was marked inhibition of acid output and pepsin concentration in all dogs for the entire 4 month period to all gastric stimuli.Acknowledgment is made to medical students Alan C. Leshnower, Dennis G. Westmoreland and John M. Eisenberg; to Jan Rubion, University of Tennessee Clinical Research Center, for the pepsin determinations; to Robert H. Murray, Surgical Research Laboratories, VA Hospital, Memphis, Tenn; to Lena Haney for histologic preparations; and to T. Bond for handling the statistical material.Supported in part, by Grant GB-7687 from the National Science Foundation.Supported by General Research Grant FR-05423, NIH, US Public Health Service.Supported by Research Grant FR-00211, US Public Health Service.     

Pseudoaneurysms complicating organ transplantation: roles of CT, duplex sonography, and angiography

In a retrospective study of proved pseudoaneurysms (PAs) in 15 patients with transplanted organs (11 liver, three kidney, one pancreas), the results of computed tomography (CT), duplex sonography, and angiography were reviewed. Of the 15 cases of PA, eight occurred at the arterial anastomosis and seven were nonanastomotic. Three of the eight anastomotic PAs were caused by infection. Of the seven nonanastomotic PAs, four were caused by percutaneous biopsy, two were caused by infection, and one was of undetermined cause. In nine (60%) of the 15 patients the PAs were incidentally detected at imaging studies performed for other reasons. Diagnosis requires a high degree of suspicion. CT was performed in nine cases and duplex sonography in ten. The diagnosis of PA was made with CT in six (67%) patients and with duplex sonography in five (50%). CT and duplex sonography could not enable diagnosis when the PA was small, when the arterial anastomosis was not included in the field of study, or when enhancement with intravenously administered contract material was suboptimal. Angiography depicted the PAs in all 15 patients. In three liver transplant recipients with gastrointestinal tract bleeding, the causative PAs were detected only with angiography.     

Outpatient therapy of intra-abdominal abscesses following early discharge from the hospital

Although percutaneous aspiration and drainage of abdominal abscesses will frequently avert an open surgical procedure, patients remain hospitalized during drainage. The authors treated 9 patients for abscesses using percutaneous drainage catheters and sent them home with the catheter in place. All had an uneventful recovery. An average of $12,050 was saved in each case. The authors suggest that outpatient drainage of abdominal abscesses is significantly less expensive than inpatient treatment, yet does not jeopardize patient care.