Resolution of multiply recurrent and multifocal diverticulitis after fecal microbiota transplantation.

BACKGROUND: The exact pathophysiology of diverticulitis is not well understood and may be multifactorial. Recent studies highlight dysbiosis as a plausible mechanism. FMT is a safe strategy to restore commensal colon microbiota and has proven to be an effective treatment for gastrointestinal dysbiosis such as Clostridium difficile infection (CDI). There have been no studies reporting the treatment of diverticulitis with FMT. Our aim was to describe the novel application of fecal microbiota transplantation (FMT) for the treatment of recurrent diverticulitis. CASE: We report a case of a 63-year-old woman who had a 13-year history of multiply recurrent and multifocal diverticulitis previously treated with numerous short courses of intravenous and oral antibiotics for acute flares, two segmental colon resections, and suppressive antibiotic therapy for recurrent disease. Secondary to multiple courses of antibiotics , the patient developed CDI. She was treated with a single round of FMT and subsequently stopped all antibiotics at the time of FMT. RESULTS: In 20 months of follow-up, the patient has had no further recurrence of diverticulitis or CDI. CONCLUSIONS: FMT could prove to be a novel therapy for refractory diverticulitis but requires further investigation.

The clinical effects of plasticizers, antioxidants, and other contaminants in medical polyvinylchloride tubing during respiratory and non-respiratory exposure.

In 1999, a Blue Ribbon Panel convened to examine the health effects of two commonly used plasticizers present in medical devices and toys. Of particular interest were the plasticizers used in medical tubing. Hospitalized patients can be exposed to a high dose of these chemicals while receiving respiratory therapy or during hemodialysis, and are more likely to be vulnerable to potentially ill effects than healthy individuals. After extensive review of existing research, the Panel concluded that there was not enough evidence of harmful health effects to remove di-(2-ethylhexyl) phthalate (DEHP) and other plasticizers from use in medical tubing. The Panel recognized the importance of plasticizers in enabling tubing such as PVC for respiratory support or in dialysis to be flexible enough for use in a variety of clinical applications that might not be possible with rigid (plasticizer-free) tubing. Nevertheless, we reviewed the literature regarding the health effects for five of the most common compounds, plasticizers and antioxidants found in medical tubing, and suggest that further clinical studies be conducted. We concur with the Panel's recommendation that alternative materials be developed and studied.

Varidase: the science behind the medicament.

Varidase is used throughout the world for the topical treatment of purulent and suppurating wounds. Its efficacy is centred on two enzymes, streptokinase and streptodornase. However, these represent only a small proportion of the bulked solid. This article gives an overview of the preparation and mode of action of Varidase, as well as showing some of the research and development that has gone into improving the assessment of its quality and composition.

An automated method for the determination of deoxyribonuclease activity as exemplified by fractionation of the components of the medicament Varidase.

The activity of most deoxyribonuclease enzymes can be monitored by measuring the change in absorbance at 260 nm which accompanies the breakdown of the double-stranded structure of native DNA. An automated method for determining deoxyribonuclease activity, based on such an absorbance change, which can overcome problems of inhibition arising from the presence of inorganic cations, is described. Variations in inorganic cation concentration is a particular problem when measuring the activity of chromatographic fractions eluted via a salt gradient. A comparison is made between the automated and a manual method for the assay of deoxyribonuclease active constituents, of the medicament 'Varidase', eluted from a Cellex-D (Bio-Rad Laboratories Ltd) anionic exchange resin using a 0.05-1.0 M sodium chloride gradient.

A guideline for anticipated blood usage during elective surgical procedures.

A realistic guideline for transfusion therapy was prepared, with the cooperation of the departments of anesthesiology and surgery, in order to reduce excessive crossmatching. The guideline recommends an ABO-Rh type and an antibody screen, instead of the ""routine'' two-unit crossmatch, for elective surgical procedures where blood is seldom used. For those operations normally necessitating hemotherapy, the number of units suggested for the preoperative crossmatch was determined by examination of the average number of units transfused in the past for that particular procedure. The guideline provides the anesthesiologic and surgical staff with the knowledge of how much blood was usually used during a particular elective surgical procedure and therefore how much blood should be preoperatively crossmatched for that procedure. Implementation of this guideline allows the blood bank to distribute its limited blood resources more efficiently and also decreases patient and laboratory costs.

The type and antibody screen, revisited.

The type and antibody screen is a safe, economical substitute for "routine" two-unit crossmatch in those elective surgical procedures rarely necessitating blood transfusion. This report confirms a previous finding that the type and antibody screen is 99.99% effective in preventing the transfusion of incompatible blood. The type and antibody screen is even safer than the stated 99.99%, when the immediate spin, saline and albumin procedures (the initial portion of the authors' complete crossmatch) are performed prior to releasing blood in an emergency situation. The immediate spin procedures not only verify the ABO compatibility but also detect any high-titer antibodies directed against low-incidence antigens that might not have been present on the screening reagent erythrocytes. The use of the type and antibody screen is applicable only in those medical facilities that have moderate reserves of blood readily available for transfusion.