Therapeutic hypothermia can be induced and maintained using either commercial water bottles or a "phase changing material" mattress in a newborn piglet model.

BACKGROUND: Therapeutic hypothermia, a safe and effective treatment for neonatal encephalopathy in an intensive care setting, is not available in low-resource settings. Aims/ METHODS: To assess two low-tech, low-cost cooling devices for use in low-resource settings: (i) commercially available water bottles filled with tepid water (25 degrees C); (ii) a mattress made of phase changing material (PCM) with a melting point of 32 degrees C (PCM works as a heat buffer at this temperature). Eleven anaesthetised newborn piglets were studied following transient hypoxia-ischaemia. The cooling device was applied 2-26 h after hypoxia-ischaemia with a target rectal temperature (T(rectal)) of 33-34 degrees C. T(rectal) undershoot was adjusted using cotton blankets; the cooling device was renewed when T(rectal) rose above 35 degrees C. T(rectal) data during cooling were dichotomised (within or without target) to assess: (a) the total period within the target T(rectal) range; (b) the stability and fluctuation of T(rectal) during cooling. RESULTS: Therapeutic hypothermia was achieved with both water bottles (n = 5) and the PCM mattress (n = 6). The mean (SD) time to reach target T(rectal) was 1.8 (0.5) h with water bottles and 1.9 (0.3) h with PCM. PCM cooling led to a longer period within the target T(rectal) range (p<0.01) and more stable cooling (p<0.05). Water bottle cooling required device renewal (in four out of five piglets). CONCLUSION: Simple, low-tech cooling devices can induce and maintain therapeutic hypothermia effectively in a porcine model of neonatal encephalopathy, although frequent fine tuning by adjusting the number of blankets insulating the piglet was required to maintain a stable temperature. PCM may induce more stable cooling compared with water bottles.

Acute upper gastrointestinal bleeding in central Greece: the role of clinical and endoscopic variables in bleeding outcome.

The objectives of this work were to portray the incidence of upper gastrointestinal bleeding in central Greece and to define subsets at higher risk of poor outcome or death. Two hundred and sixty-four cases were recorded. The incidence was 116 per 100,000 per year (95% CI: 102-130). Re-bleeding was noted in 7.9% of patients. The case fatality was 7.2% and population mortality 8 per 100,000 per year (95% CI: 4-12). Independently significant risk factors for re-bleeding were stigmata of bleeding at endoscopy (OR: 3.11; 95% CI: 1.06-9.13, P = 0.04), smoking (OR: 3.39; 95% CI: 1.08-10.62, P = 0.03), and the use of anti-coagulant drugs (OR: 2.64; 95% CI: 1.00-7.13, P = 0.05), while the independently significant risk factor for death was re-bleeding (OR: 5.74; 95% CI: 1.40-23.52, P = 0.03). We conclude that patients with stigmata of bleeding at endoscopy and on anti-coagulant therapy should be under close surveillance because of the higher risk of re-bleeding. Smoking also increases the risk of re-bleeding. Patients with re-bleeding episodes must be managed intensively because of the higher risk of death.

Amaranthin lectin binding in the rat colon: response to dietary manipulation.

BACKGROUND: In human colon, binding of the lectin Amaranthus caudatus has been considered to be a marker of cellular proliferation and malignant progression. We studied regional amaranthin binding in rat colon and correlated this with physiologic manipulations of proliferation. METHODS: Binding of amaranthin in segments of proximal and distal colon was studied in starved, refed, and control Wistar rats and was compared to tritiated thymidine labeling and proliferating cell nuclear-antigen expression. RESULTS: Amaranthin bound mainly to cells in the lower crypt of distal colon and midcrypt of proximal colon, paralleling the distribution of proliferative markers. Binding occurred in the supranuclear region in distal colon and the pericellular membrane in proximal colon. Starvation/refeeding was associated with a change in amaranthin binding intensity in distal colon, but not in proximal colon. CONCLUSION: The pattern of amaranthin binding during starvation/refeeding seems to reflect physiologic changes in several areas of the colon.

Is Ki-67 a better proliferative marker in the colon than proliferating cell nuclear antigen?

Endogenous markers of proliferating cells have increasingly supplanted the use of incubation of biopsy tissues in vitro with tritiated thymidine or with bromodeoxyuridine, thus avoiding the potential variation resulting from the incubation procedure. Antibodies to proliferating cell nuclear antigen (PCNA) such as PC10 have been promoted as optimal for this purpose, although considerable variation in colonic proliferating cells with this antibody has been reported. We have compared the detection of colonic proliferating cells in normal mucosa and adenomata using the PC10 monoclonal antibody (mAb) to PCNA and the Mib-1 mAb to Ki-67 in formalin-fixed tissues using antigen retrieval solutions with microwaving. The PC10 antibody showed variable immunostaining of proliferating and nonproliferating cells with minor changes in primary antibody concentration or microwave conditions and between normal and adenomatous tissue. In contrast, Mib-1 immunostaining was quite constant with differing antigen retrieval and antibody conditions and similar staining of proliferating cells in colonic adenomas. Some loss of immunoreactivity occurred if the cut sections were not immunostained within approximately 1 week. These data suggest that whereas PCNA immunohistochemistry is satisfactory when carefully controlled in large chemopreventive studies, the Mib-1 mAb to Ki-67 is superior to PCNA antibodies in immunostaining proliferating cells in the formalin-fixed human colon.

Efficacy of repeated therapeutic endoscopy in patients with bleeding ulcer.

BACKGROUND/AIMS: Although therapeutic endoscopy is regarded as the procedure of choice for bleeding ulcers, the disease mortality is barely altered. The aim of the present study was to evaluate the efficacy of repeated therapeutic endoscopy in patients with bleeding ulcer. METHODS: From January 1990 to April 1995, 727 patients with bleeding ulcers were admitted to hospital under the care of one gastroenterologist who endoscoped every patient within 18 hours of admission. Epinephrine (1:10,000) was injected into the lesions of patients found to have active bleeding, a non-bleeding visible vessel, or adherent red clot. After the initial diagnostic-therapeutic procedure, all patients admitted from 1990-92 (group A) were treated conservatively, and referred for operation if re-bleeding was uncontrolled. Patients admitted from 1993 to April 1995 (group B) were treated aggressively with re-endoscopy one day later, and repeat hemostasis if re-bleeding was evident. During hospitalization, diagnostic/therapeutic endoscopy was then repeated if re-bleeding was diagnosed by either a fall in hematocrit of > 3%, or on clinical criteria. Patients were transfused if the hematocrit fell to < 30%. RESULTS: Repeated hemostasis was needed in 30 group B patients; one patient requiring 7 therapeutic endoscopies. The outcome of patients in group B was better than group A, with fewer emergency operations (3 vs 10) (p < 0.05) and deaths (0 vs 4) (p < 0.05), while no difference was seen in transfusion requirements (4.1 vs 3.9 units) (p > 0.1), or in length of hospital stay (6.8 vs 7.1 days) (p > 0.1). CONCLUSION: Repeated diagnostic/therapeutic endoscopy benefits patients with bleeding ulcers.

Solitary juvenile polyps in children and colon cancer.

BACKGROUND/AIMS: Solitary Juvenile Polyps (SJP) are quite common in preschool children, although they may occur at any age. It is not known whether the existence of a single juvenile polyp in a child predisposes to future development of new SJP or is related to colorectal neoplasia. The present study was designed to follow up young patients who had undergone polypectomy for SJP and their first degree relatives to elucidate the development of adenomatous polyps or colon cancer. MATERIALS AND METHODS: From 31 children polypectomized for histologically proven SJP between 1983-1995, we were able to contact and gather information on 24. From our records and the information collected we studied age, gender, site of the polyp in the bowel, personal history, and family history. RESULTS: Mean time of follow up was 4.1 years (range 0.4-10, SD +/- 3.1) Mean age was 4.6 years (Range 3.5-9, SD +/- 1.2). There were 14 boys and 10 girls (ratio 1.4/1). Eighteen polyps were located at the rectosigmoid area, 5 in the lower descending colon, and one in the splenic flecture. From the 24 children, only one girl developed rectal bleeding at the age of 15 years, 8 years after polypectomy. However, subsequent evidence from the large bowel did not reveal any abnormality and the symptom was attributed to hemorrhoidal bleeding. Thorough investigation of the history of 146 first degree relatives (dead or alive) siblings, parents, and grandparents revealed that none of them were diagnosed with adenomatous polyps or colorectal cancer. CONCLUSION: SJP does not predispose to future development of new juvenile polyps and is not associated with a high risk of colorectal malignancy.

Transarterial locoregional immunostimulation and chemotherapy in patients with unresectable secondary liver tumours.

Ten patients with unresectable liver secondaries from colorectal carcinoma were included in this study. All patients were treated with combined locoregional transarterial targeting immunostimulation and chemotherapy. After abdominal surgery for the introduction of an arterial catheter into the hepatic artery via the gastroduodenal artery, all patients survived the operation and their response to the treatment was satisfactory. At present, seven patients are alive with a survival ranging from 6 to 19 months (mean survival 12 months). Three patients died from their disease after 12, 8 and 7 months respectively. We were able to demonstrate significant tumour necrosis in all patients, even after the first series of combined immunotherapy and chemotherapy. It is concluded that locoregional transarterial targeting immunostimulation and chemotherapy is a promising alternative for patients with unresectable liver secondaries. Further studies are warranted to elucidate the impact of this new treatment modality on overall survival.

Diet and other factors in the aetiology of diverticulosis: an epidemiological study in Greece.

A case control study exploring the role of diet and other biosocial factors in the aetiology of diverticulosis was undertaken in Athens, Greece, in 1981-1982. One hundred consecutive cases with radiologically confirmed diverticulosis and 110 control patients with fractures or other orthopaedic disorders were submitted to a structured interview, including frequency of consumption of about 80 food items. The main positive findings were, (i) the cases reported significantly less frequent consumption of vegetables, brown bread and, to a lesser extent, potatoes and fruits, and (ii) the cases reported significantly more frequent consumption of meat and, to a lesser extent, milk, and milk products. The difference in risk between those people who frequently consume vegetables but rarely consume meat, and those who rarely consume vegetables and frequently consume meat, was almost 50-fold.