Heterotopic perineal intestinal mucosa —a variant of the exstrophy-epispadias complex

We report two cases of sequestration of a segment of intestinal mucosa in the perineal area. In one patient this was associated with a mildly ectopic anus. No abnormalities were identified in the bladder, urethra, vagina, or rectum. The lesions were treated by excision following complete anatomical mapping.     

Protective role of neurotrophins in experimental inflammation of the rat gut

BACKGROUND & AIMS: Sensory neuropeptides modulate the mucosal response to inflammation in experimental colitis. Because nerve growth factor (NGF) regulates the expression of neuropeptides such as substance P and calcitonin gene-related peptide (CGRP) and is implicated as a link between the nervous system and the immune system in the inflammatory process, we investigated the functional role of NGF and neurotrophin-3 during experimental colitis. METHODS: Immunoneutralizing antibodies specific for NGF and neurotrophin (NT)-3 were used to block their endogenous activity. Mild trinitrobenzene sulfonic acid (TNBS) colitis was induced, and damage scores were assessed after 1 week. Neuropeptide content in the colon and NT messenger RNA (mRNA) expression were determined. RESULTS: The pretreatment with anti-NGF or anti-NT-3 caused a significant 2-3-fold increase in the severity of the experimental inflammation as assessed by a macroscopic damage score, histologic ulceration score, and myeloperoxidase activity in the tissue. CGRP, but not substance P, contents in the colon were significantly reduced by NGF immunoneutralization. NGF mRNA was slightly up-regulated after NGF immunoneutralization, but NT-3 mRNA was unchanged by NT-3 immunoneutralization. CGRP mRNA was not significantly changed after 1 week of colitis by NGF or NT-3 immunoneutralization, whereas beta-preprotachykinin mRNA was up-regulated after immunoneutralization. CONCLUSIONS: These findings suggest a regulatory role for NGF and NT-3 in experimental inflammation of the gut. This effect may be partly caused by the reduction of mucosal CGRP content caused by the NGF blockade.     

Accelerated in vitro degradation of CCK-58 in blood and plasma of patients with acute pancreatitis

Proteases released into the circulation during acute pancreatitis may hydrolyse circulating peptide hormones leading to altered regulatory functions. Cholecystokinin is a major regulator of postprandial gut function; stimulating pancreatic enzyme secretion, gallbladder contraction and diminishing food intake. Cholecystokinin-58 is the largest and most abundant form of this hormone in acid extracts of human intestine, and major amounts are released into the circulation after feeding. In order to test whether cholecystokinin-58 is degraded more rapidly due to the increased circulating of enzymes, this peptide was added to blood and plasma of patients with acute pancreatitis and incubated for various time intervals. The in vitro half life of cholecystokinin-58 was 10 +/- 1 minutes (mean +/- SE) in plasma and 11 +/- 1 min in blood from patients with acute pancreatitis, about four fold lower than the half life in plasma of healthy volunteers; 45 +/- 5 min. Degradation of cholecystokinin-58 produced immunoreactive forms of cholecystokinin that eluted in the positions of cholecystokinin-8 and cholecystokinin-33/39. We conclude that acute pancreatitis increases the degradation of CCK molecules.     

鸟氨酸α酮戊二酸强化营养对大鼠癌性恶病质的作用:切除肿瘤可以提高营养支持的作用

探讨鸟氨酸α酮戊二酸对负荷肝细胞瘤Morris7777大鼠的作用。大鼠分别接受等氮、热卡的含鸟氨酸α酮戊二酸或甘氨酸的饲料。鸟氨酸α酮戊二酸已用于其它一些分解代谢状态（如创伤、败血症）。肿瘤植入自然生长3周后达11g／（100g体重），此时可以引起进行性的厌食、负氮平衡以及机体和组织的消耗。与甘氨酸比较，鸟氨酸α酮戊二酸既没有影响肿瘤的生长也没有改变肿瘤引起的宿主分解代谢变化。认为本研究以及当肿瘤占宿主体重4％～30％的报告中，强化营养支持效果欠佳的原因是由于肿瘤夺取了宿主的氨基酸。本实验证明肿瘤植入3周后，肿瘤自身的蛋白积累和对氨基酸氧化分解占宿主每日摄入蛋白量的～70％。由于临床工作中肿瘤总是在较小时被诊断并行初次治疗的。本实验进一步研究了手术切除肿瘤以限制疾病阶段后强化营养的作用。大鼠术前3天和术后3天或6天分别接受鸟氨酸α酮戊二酸或甘氨酸的饲料。鸟氨酸α酮戊二酸强化营养的大鼠其氮平衡、肌肉谷氨酰胺和支链氨基酸浓度、小肠蛋白积累高于甘氨酸强化营养的大鼠（P＜0．05）。本实验证明不切除肿瘤仅行营养支持其效果欠佳，而且为进一步实验研究建立了恰当的动物模型。     

Lack of agreement in classification of the severity of acute asthma between emergency physician assessment and classification using the National Asthma Council Australia guidelines (1998)

Aims: To determine the level of agreement in classification of the severity of acute asthma at presentation to the emergency department, between emergency physician global assessment and severity classification according to the National Asthma Council Guidelines, Australia 1998 (NACG). Methods: Prospective observational study in emergency departments throughout Australia, participating in the Asthma Snapshot 2000 project. Patients between the ages of one and 60 years presenting to participating emergency departments with acute asthma between 21 August and 3 September 2000 were included. Data collected were emergency physician global assessment of asthma severity and severity classification according to the National Asthma Council Guidelines and disposition. Results: Five hundred and five subjects had completed data for emergency physician assessment of severity and for calculation of severity classification according to the National Asthma Council Guidelines. Weighted kappa for agreement in classification was 0.48 (95% confidence interval: 0.40, 0.56). Emergency physicians assess asthma as less severe compared to the National Asthma Council Guidelines assessment. Conclusions: Agreement between physician assessment of severity of acute asthma and severity classification according to National Asthma Council Guidelines is only moderate. This may have implications in treatment and disposition. This also suggests that emergency physicians may be using other methods to classify acute asthma than the National Asthma Council Guidelines classification.     

Update on Percutaneous Mechanical Mitral Commissurotomy

A reusable metallic valvotomy device has been developed with the goals of improving the results of percutaneous mitral valvotomy and increasing the cost-effectiveness of the procedure. The device consists of a detachable and reusable metallic dilator with two articulated bars screwed at the distal end of a catheter. Using transseptal catheterization, the device is placed across the valve over a traction guidewire and then opened gradually by means of pliers up to a maximum of 40 mm. To date, the device was used in 168 patients with a broad spectrum of mitral valve disease. The procedure was successful in 95% of cases and resulted in an increase in mitral valve area from 1.01 ± 0.8 to 2.20 ± 0.7 cm². No increase in mitral regurgitation was noted in 87% of cases. Bilateral splitting of the commissures was observed in 89%. Complications included the following: 2 severe mitral regurgitations (one requiring surgery), 1 pericardial tamponade, 1 transient cerebrovascular embolic event. The maximum number of consecutive patients treated with the same device was 35. The results obtained are at least comparable to those of current balloon techniques and confirm the possibility of safe multiple reuses of the device after sterilization.