A 6-year review of surgical morbidity and oncological outcome after high anterior resection for colorectal malignancy with and without splenic flexure mobilization

Objective High anterior resection (HAR) for colorectal cancer is traditionally performed with routine mobilization of the splenic flexure. This is a retrospective review of mortality and morbidity following HAR in which the splenic flexure has been preserved. Method From a prospective database, all patients who had undergone elective HAR for colorectal cancer between 1999 and 2005 were identified. Morbidity, mortality, pathology and survival data for patients having HAR with and without splenic flexure mobilization were analysed. Results A total of 707 patients were identified. Five hundred and thirty‐one had HAR with preservation of the splenic flexure. In these patients outcome was: anastomotic leak (0.4%), wound infection (3.6%), anastomotic stricture (0.4%) and 30‐day mortality (0.9%). No statistical significant difference was found for postoperative morbidity (P = 0.1926), 30‐day mortality (P =0.3285), lymph node harvest (P = 0.2127) or survival (P = 0.1457) compared with patients in whom the splenic flexure was mobilized. Longitudinal resection margins were greater following HAR with splenic flexure mobilization (P < 0.0001). Conclusion No morbidity, oncological or survival disadvantage in performing splenic flexure preserving HAR was found.     

Oxidative injury triggers autophagy in astrocytes: The role of endogenous zinc

We have recently demonstrated that the accumulation of labile zinc in lysosomes during oxidative stress causes lysosomal membrane permeabilization (LMP) in cultured hippocampal neurons. Since autophagy involves fusion of autophagic vacuoles (AVs) with lysosomes, zinc accumulation may start in AVs. In the present study, we examined the role of endogenous zinc in H₂O₂‐induced autophagy and cell death in mouse astrocyte cultures. Live‐cell confocal imaging of astrocytes transfected with GFP‐LC3 revealed that the number of AVs positive for LC3 (microtubule‐associated protein 1 light chain 3) increased following exposure to H₂O₂ or ferrous chloride (FeCl₂). Staining of RFP‐LC3‐transfected astrocytes with FluoZin‐3 indicated that the levels of labile zinc increased in AVs as well as in the cytosol and nuclei. The majority of AVs were double‐stained with LysoTracker, indicating that they were fused with lysosomes. Chelation of zinc with tetrakis [2‐pyridylmethyl]ethylenediamine (TPEN) decreased the number of AVs in H₂O₂‐treated astrocytes, whereas exposure to zinc increased their number, suggesting that dysregulation of zinc homeostasis is mechanistically linked to autophagy. Unexpectedly, inhibition of autophagy blocked the rise in labile zinc levels. Astrocytic death induced by H₂O₂ was accompanied by LMP. Autophagy inhibitors (3‐methyladenine, bafilomycin‐1) or TPEN attenuated LMP and cell death in astrocytes. These results support the possibility that endogenous zinc plays a key role in autophagy under oxidative stress in astrocytes, and suggest that autophagy is a necessary preceding event for LMP and cell death in oxidative injury. © 2009 Wiley‐Liss, Inc.     

Arterial stiffness, metabolic syndrome and inflammation amongst Asian ischaemic stroke patients

Background and purpose:  Arterial stiffness and metabolic syndrome (MetS) are risk factors for ischaemic stroke. We studied the association of arterial stiffness, measured by carotid–femoral pulse wave velocity (PWV) and MetS amongst ischaemic stroke patients. We also investigated the role of inflammation measured by serum erythrocyte sedimentation rate (ESR) in the metabolic syndrome–arterial stiffness relationship.
Methods:  Amongst the 229 prospectively recruited acute ischaemic stroke patients, we measured carotid–femoral PWV using applanation tonometry and the inflammatory marker serum ESR.
Results:  Carotid–femoral PWV was significantly higher amongst patients with MetS ( P  = 0.002), increased waist circumference ( P  = 0.010), raised blood pressure ( P  < 0.001) and abnormal glycemia ( P  = 0.002); and increased with the number of MetS components ( P  = 0.002). In a sub-group of 199 patients, carotid–femoral PWV was significantly correlated with serum ESR ( P  < 0.001). In multivariate regression analysis including serum ESR and MetS as variables, carotid–femoral PWV was independently associated with higher ESR ( P  = 0.002) but not with MetS ( P  = 0.139).
Conclusions:  Arterial stiffness is significantly associated with MetS amongst ischaemic stroke patients, and inflammation appears to be involved in this relationship.     

Association of acute ischemic stroke with the MTHFR C677T polymorphism but not with NOS3 gene polymorphisms in a Singapore population

Background and purpose: The association of polymorphisms in the nitric oxide synthase 3 (NOS3) gene (T‐786C, variable number tandem repeats 4A/B/C, and G894T) and in the methylenetetrahydrofolate reductase (MTHFR) gene (C677T) with acute ischemic stroke have been reported. Methods: First‐time onset acute ischemic stroke patients (n = 120) and controls (n = 207) with no past history of stroke were compared. Allele specific gene amplification and restriction fragment length polymorphism (RFLP) analysis were used to determine the genotype and allelic frequencies in both groups. Plasma homocysteine (Hcy) and nitrite levels were measured. Results: No significant association of NOS3 polymorphisms with ischemic stroke was noted. The TT genotype of the MTHFR C677T polymorphism was significantly associated with ischemic stroke (P = 0.004). Elevated plasma Hcy levels were also significantly associated with ischemic stroke (P = 0.001). Conclusions: The TT genotype of C677T polymorphism in the MTHFR gene contributes to genetic susceptibility of acute ischemic stroke in a Singapore population.     

Efficacy of transarterial embolization as definitive treatment in lower gastrointestinal bleeding

Transarterial catheter embolization (TAE) is integral in the management of lower gastrointestinal bleeding (BLGIT). The efficacy of superselective embolization has reduced the need for emergent surgical resection as a treatment modality.
Objective  To determine the outcomes of TAE in the management of BLGIT in terms of efficacy rates, recurrent bleeding rates and long term results without the need for surgical intervention.
Method  Patients who underwent TAE for BLGIT between September 2000 and May 2006 were analysed. Data were extracted from the records for analysis.
Results  Sixty-eight patients with a mean age of 76 years and equal gender distribution were analysed. Sixty-nine per cent presented with haematochezia, 40% with malena. Sixty-three patients had a prior RBC scan performed, all of which were positive. Colonoscopy was attempted in 18 patients of which four managed to localize the bleeding site. Embolization was performed in these patients using mainly polyvinyl alcohol particles and/or microcoils. The morbidity rate was 21%, comprising mainly fever and nonspecific abdominal pain with only four ischaemic complications and one report of colonic infarction. Early recurrent bleeding occurred in six patients. Three were treated with repeat embolization and two required surgery. There were no mortalities. After a mean follow-up of 12 months, 12 (17.6%) patients developed further episodes of BLGIT, necessitating further intervention.
Conclusion  Transarterial catheter embolization is effective and safe in the acute management of BLGIT and reduces the need for further definitive surgery in a majority of patients.     

Immunosuppression after injection of Friend virus into C57BL/6 mice of different ages

Injection with Friend virus (FV) causes immunosuppression in young and old C57BL/6 mice, i.e. it occurs whether or not the virus replicates very briefly or for a long period. There are only minor age-related differences in the extent of immunosuppression, except that suppression appears to persist somewhat longer in old than in young animals.     

Nutrient intake of low-income, black families in southwestern Mississippi

A dietary intake study for 250 low-income households in Claiborne County in southwestern Mississippi was conducted from June through August 1974. Data were obtained during daily home visits for seven days by trained college students. The adequacy of nutrient intake for individuals was evaluated by comparing the data with the 1974 Recommended Dietary Allowances by age and sex. The data was also compared with those of the Ten-State Nutrition Survey and HANES. Mean intakes of protein, vitamin A, thiamin, riboflavin, and ascorbic acid for all subjects were above the RDAS; those of energy, calcium, iron, and preformed niacin were below the allowances. Whereas calcium was the nutrient least adequately consumed by all persons, protein was most adequately consumed. Sixty per cent of children had calcium intakes below two-thirds of the allowance. By sex, 66.7 per cent of all males and 73.3 per cent of all females had calcium intakes below two-thirds of the standard. None of children received less than two-thirds of the allowance for protein. Nutrient intake was low for a substantial number of the subjects. Adolescents, ages eleven to eighteen years, of both sexes had the poorest diets for all nutrients. Regarding the sex difference, females had better nutrient intakes than did males for all nutrients except calcium and iron.     

Transurethral microwave coagulation of bladder cancer in elderly patients

Since April 1985, 72 patients with bladder cancer have been treated by transurethral microwave coagulation (TUMC). In this procedure, tumors were irradiated with microwave energy of 100 watts for 2-16 minutes. A total of 20 patients were 70 years old or older, including 5 who were more than 80 years old. These 20 patients have been followed for 6 to 32 months with a median follow-up of 14.7 months. After TUMC, tumors completely disappeared endoscopically and histologically in all patients. Four patients had heterotopic recurrences. In all patients, serious complications were not seen during and after TUMC. Our clinical experience revealed that TUMC was the useful therapeutic method for bladder cancer in elderly or poor-risk patients. In this paper, we describe the technique of TUMC and preliminary clinical results.