Long-term follow-up of mechanical anastomoses in surgery of the large intestine. Prospective study of 683 patients

The long-term results of colorectal and coloanal anastomoses using the EEA, SPTU and ILS circular staplers are reviewed. Anastomoses with these stapling devices were performed in 683 patients between September 1978 and April 1982. 91% of patients with rectal carcinoma underwent rectal resection and restoration of bowel continuity. All patients were operated on for the same way. We used a cancericidal rectal irrigation with 5.0% Sublimate (HgCl2) regularly in all patients with carcinoma. The inferior mesenteric artery is ligated and divided, preserving the arcade between the ascending and descending branch of the left colonic artery. The incidence of postoperative complications amounted to 17%. Intraoperative complications occurred in 12,7% (anastomotic leak 8%, difficult extraction 1,5%, bleeding 0,4%, instrument failure 2,8%). The incidence of dehiscence of anastomosis after low anterior resection (n = 422) was 15% and 3% after high anterior resection (n = 261). The clinical leakage in both groups was 4.2 and 2.3% respectively. Two of 23 patients died because of anastomotic leakage only .4 patients (1.3%) have been observed to develop a recurrent anastomotic tumour and 18 (5.8%) developed a recurrent pelvic tumour. To test the sphincter function after a very low colo-rectal anastomosis (3.5 to 5 cm from cutaneous-anal verge) 32 patients were examined by using manometric studies. There were no statistically differences between normal subjects and those patients in resting pressure, maximum squeeze pressure, and length of anal canal. A significantly lower rectal compliance and rectal capacity could be found.     

Collaborative evaluation of the microbial profile system for quantitative antimicrobial susceptibility testing.

This three-center collaborative study was conducted to evaluate samples of the Microbial Profile System (MPS) antimicrobial microdilution panels [previously produced by Minnesota Mining & Manufacturing Co., (3M Co.), St. Paul, Minn. and currently produced by Flow Laboratories, Inc., Rockville, Md.). This was a three-phase study. In phase I, the inter- and intralaboratory agreement was determined by using strains with selected ranges of susceptibility. The MPS and reference microdilution minimum inhibitory concentrations were within acceptable variation, +/- 1 dilution for 97.7% for the MPS and 98.8% for the reference microdilution panels for the intralaboratory comparisons. The percentage of strains with minimum inhibitory concentrations in the acceptable range for the interlaboratory variation was 96.2% for the MPS and 96.0% for the reference microdilution panels. The phase II studies used strains with known resistance mechanisms. The percent agreement with these strains was: Enterobacteriaceae, 94.5%; nonenteric gram-negative rods, 95.4%; staphylococci, 92.3%; and streptococci, 96.6%. The overall agreement within acceptable limits was 94.7% with these strains. When testing 359 clinical isolates, the frequency of strains within the acceptable range of agreement between the two methods was 97.3%. The MPS panels gave results in each of the three study phases equivalent to those obtained with the reference microdilution panels.     

Digital movement analysis,a new objective method of measuring tardive dyskinesia and drug-induced parkinsonian tremor: acceptability,reliability and validity

Digital movment analysis (DMA) is a new instrumental approach to assessing oral tardive dyskinesia (TD) by means of digital image processing of a video signal, tracking five paper dots placed around the patient's mouth. A total of 40 schizophrenic patients, 30 with and 10 without TD, were examined twice (with a 3-month interval) with this new device. The patients were further examined with two TD rating scales: the St. Hans Rating Scale for extrapyramidal syndromes (SHRS) and the Abnormal Involuntary Movement Scale (AIMS).The schizophrenic patients accepted the instrumental assessment without any anxiety or resistance. The internal relibility of the apparatus was high, with correlation coefficients of 0.80–0.99. The DMA TD values correlated with the SHRS and AIMS scores with correlation coefficients of 0.48–0.73 indicating an acceptable, although not strong, concurrent validity. Fluctuations occurred from the first to the second examination independent of medication. For these fluctuations no correlation was found between DMA values and rating scores. Finally, the DMA device was able to detect perioral tremor as a sign of parkinsonism.It has been concluded that DMA is a useful supplement to classical TD rating, although further validity evaluation is warranted.     

Use of an Actinobacillus pleuropneumoniae multiple mutant as a vaccine that allows differentiation of vaccinated and infected animals

Vaccination against Actinobacillus pleuropneumoniae is hampered by the lack of vaccines inducing reliable cross-serotype protection. In contrast, pigs surviving natural infection are at least partially protected from clinical symptoms upon reinfection with any serotype. Thus, we set out to construct an attenuated A. pleuropneumoniae live vaccine allowing the differentiation of vaccinated from infected animals (the DIVA concept) by successively deleting virulence-associated genes. Based on an A. pleuropneumoniae serotype 2 prototype live negative marker vaccine (W. Tonpitak, N. Baltes, I. Hennig-Pauka, and G.-F. Gerlach, Infect. Immun. 70:7120-7125, 2002), genes encoding three enzymes involved in anaerobic respiration and the ferric uptake regulator Fur were deleted, resulting in a highly attenuated sixfold mutant; this mutant was still able to colonize the lower respiratory tract and induced a detectable immune response. Upon a single aerosol application, this mutant provided significant protection from clinical symptoms upon heterologous infection with an antigenically distinct A. pleuropneumoniae serotype 9 challenge strain and allowed the serological discrimination between infected and vaccinated groups.     

Anti‐retroviral effects of type I IFN subtypes in vivo

Type I IFN play a very important role in immunity against viral infections. Murine type I IFN belongs to a multigene family including 14 IFN‐α subtypes but the biological functions of IFN‐α subtypes in retroviral infections are unknown. We have used the Friend retrovirus model to determine the anti‐viral effects of IFN‐α subtypes in vitro and in vivo. IFN‐α subtypes α1, α4, α6 or α9 suppressed Friend virus (FV) replication in vitro, but differed greatly in their anti‐viral efficacy in vivo. Treatment of FV‐infected mice with the IFN‐α subtypes α1, α4 or α9, but not α6 led to a significant reduction in viral loads. Decreased splenic viral load after IFN‐α1 treatment correlated with an expansion of activated FV‐specific CD8⁺ T cells and NK cells into the spleen, whereas in IFN‐α4‐ and ‐α9‐treated mice it exclusively correlated with the activation of NK cells. The results demonstrate the distinct anti‐retroviral effects of different IFN‐α subtypes, which may be relevant for new therapeutic approaches.     

Salmonella pathogenicity island 4-mediated adhesion is coregulated with invasion genes in Salmonella enterica

Salmonella pathogenicity island 4 (SPI4) encodes a type I secretion system and the cognate substrate protein, SiiE. We have recently demonstrated that SiiE is a giant nonfimbrial adhesin involved in the adhesion of Salmonella enterica serovar Typhimurium to polarized epithelial cells. We also observed that under in vitro culture conditions, the synthesis and secretion of SiiE coincided with the activation of Salmonella invasion genes. These observations prompted us to investigate the regulation of SPI4 genes in detail. A novel approach for the generation of reporter gene fusions was employed to generate single-copy chromosomal fusions to various genes within SPI4, and the expression of these fusions was investigated. We analyzed the regulation of SPI4 genes and the roles of various regulatory systems for SPI4 expression. Our data show that the expression of SPI4 genes is coregulated with SPI1 invasion genes by the global regulator SirA. Expression of a SPI4 gene was also reduced in the absence of HilA, the central local regulator of SPI1 gene expression. Both SirA and HilA functions were required for the secretion of SiiE and the SPI4-mediated adhesion. Our data demonstrate that SPI4-mediated adhesion, as well as SPI1-mediated invasion, are tightly coregulated by the same regulatory circuits and induced under similar environmental conditions.