Comparison of early postoperative enteral nutrients versus chow on colonic anastomotic healing in normal animals

We aimed to clarify the effects of different enteral nutrients (normal chow, complete balanced nutrition, elemental nutrition enriched with glutamine, immune-enhancing diet and fiber) on colonic anastomotic healing in the stress-free metabolic state. The study was carried out with 50 male Balb-C mice in five groups of 10 animals each. After transverse colon anastomosis, animals were fed with early enteral nutrients using normal chow (group 1), Ensure((R)) (group 2), Alitraq((R)) (group 3), Impact((R)) (group 4), and Benefiber Resource((R)) orange juice drink (group 5) for 7 days. There were no significant differences among the groups in bursting pressure (p > 0.05). There was no statistical difference in terms of hydroxyproline level among groups 1-3. The hydroxyproline levels of groups 4 and 5 were statistically higher than that of the control group (p < 0.05 for both comparisons). Under normal conditions without stress, we could not demonstrate the superior effects of early enteral feeding with specialized enteral preparations over normal diets on colonic anastomoses when the bursting pressures were compared.     

99mTc-MIBI SPET in non-small cell lung cancer in relationship with Pgp and prognosis

Higher technetium-99m methoxyisobutylisonitrile (MIBI) uptake in non-small cell lung cancer (NSCLC) has been reported to be associated with a positive response to chemotherapy. It has previously been found that in tumour cells, P-glycoprotein (Pgp) expression is of importance for tracer uptake. However, some studies have indicated that Pgp expression does not play an important role in (99m)Tc-MIBI uptake in NSCLC; indeed, a negative correlation between (99m)Tc-MIBI uptake and Pgp expression has been reported. Against the background of conflicting results, our aim was to evaluate the relationship between (99m)Tc-MIBI uptake, prognosis and Pgp expression in NSCLC. A total of 37 patients with NSCLC underwent (99m)Tc-MIBI single-photon emission tomography (SPET) before chemotherapy. In 19 patients both Pgp and p53 expression, and in two patients only p53 expression (due to the limited biopsy material), were measured with immunohistochemical staining. (99m)Tc-MIBI uptake was significantly higher in responders than in non-responders: 3.09+/-1.14 vs 2.24+/-0.88 ( P<0.03) and 3.09+/-1.08 vs 2.37+/-1.06 ( P<0.05) for the early ratio (ER) and the delayed ratio (DR), respectively. The wash-out rate (WR) of responders was not significantly different from that of non-responders. We found no significant differences in ER, DR and WR among the groups positive or negative for Pgp and p53 status. There was a significant positive correlation between the survival rate and both ER and DR: r=0.49 ( P=0.003) and r=0.40 ( P=0.018), respectively. Patients with ER and DR values above 3 showed significantly longer survival than those with values below 3: 14.7+/-8.5 months vs 7.3+/-5.1 months ( P<0.009) and 13.2+/-8.4 months vs 7.4+/-5.3 months ( P<0.04) for ER and DR, respectively. However, interestingly, and in contrast to expectations, patients with a Pgp score of +2 showed significantly longer survival (12.9+/-6.7 months) than those with Pgp scores of +1 (4.4+/-3.0 months) or - (negative) (3.8+/-2.2 months) ( P<0.009 and P<0.02, respectively). Our results suggest that in NSCLC, patients with higher (99m)Tc-MIBI uptake tend to show a positive response to chemotherapy, and patients with ER and DR values above 3 have a significantly better prognosis. We also found that Pgp expression seems to play only a minor role in (99m)Tc-MIBI uptake. Our finding that patients with ER and DR values above 3 have a better prognosis needs to be confirmed in larger series of patients.     

Results of intravenous regional anaesthesia with distal forearm application

The aim of this study was to evaluate the clinical effectiveness of distal forearm intravenous regional anaesthesia (IVRA) with the tourniquet applied 3 cm above the wrist. One hundred and twenty patients undergoing out-patient hand surgery were operated for 13 different hand problems under distal forearm IVRA, using 10 ml of a solution containing 1.5 mg/kg prilocaine. Sensory block onset time was 4.5 minutes (3.5-6.5 min.). Mean tourniquet time was 17.6 minutes (range, 7-27.5 min). Mean tourniquet pressure was 240 mmHg (range, 220-270 mm Hg). The mean VAS score for tourniquet pain was 3.8 (range, 2-10). No local or systemic side effects related to the IVRA were observed. The study showed that distal forearm IVRA using 10 ml of a solution containing 1.5 mg/kg prilocaine provides safe, rapid and effective anaesthesia for patients undergoing outpatient hand surgery.