Circumferential stapled procedure for bleeding ano-rectal varices is an effective treatment--experience in nine patients.

OBJECTIVE: The objective of this study was to demonstrate that stapled disruption of rectal varices is a feasible and suitable method of controlling bleeding varices. METHOD: Patients known to have bleeding rectal varices secondary to liver failure were offered this procedure. All these patients had failed medical and endoscopic management. All nine patients underwent the procedure as an emergency, with the intention of controlling haemorrhage. The procedure was carried out under general anaesthetic by a colorectal surgeon experienced in using the stapled device for haemorrhoidectomy. RESULTS: Nine patients underwent this procedure, with successful control of bleeding achieved in all. Follow-up period from 4 to 24 months revealed no further re-bleeding. CONCLUSION: We conclude that stapled disruption of bleeding rectal varices in patients with known portal hypertension is a very useful and effective procedure when carried out by an experienced colorectal surgeon.

Experimental gestational pyelonephritis induces preterm births and low birth weights in C3H/HeJ mice.

Urinary tract infections (UTIs) are associated with approximately 27% of premature births. Escherichia coli is the most frequent causal agent of UTIs and expresses virulence factors, including surface adhesins that recognize specific host tissue receptors. We have reported that E. coli Dr adhesin recognizes decay-accelerating factor as the host tissue receptor and that these receptors are increased during pregnancy. Induction of pathogenesis is a cumulative effect of the host-pathogen relationship involving specific host factors and virulence characteristics of the invading organism. Recently, an experimental model of chronic pyelonephritis has been developed with E. coli bearing Dr adhesin (E. coli Dr(+)) in nonpregnant lipopolysaccharide hyporesponder C3H/HeJ mice. In this study, we investigated the role of E. coli Dr(+) on the outcome of pregnancy in C3H/HeJ mice. Groups of pregnant mice were infected with E. coli Dr(+) or its isogenic mutant which does not bear the Dr adhesin (E. coli Dr(-)) by urethral catheterization. Nearly 90% of pregnant mice infected with E. coli Dr(+) delivered preterm (before 90% gestation) compared to 10% of mice infected with E. coli Dr(-) and none of the mice treated with phosphate-buffered saline (PBS). Also, there was a significant reduction in fetal birth weight in the E. coli Dr(+)-infected group compared to the E. coli Dr(-)- and PBS-treated groups (P = 0.003). This experimental model of E. coli Dr(+)-induced preterm delivery in mice may help in understanding the molecular mechanisms involved in UTI-induced preterm labor involving bacterial adhesins.

Rapid cyclic changes in density and accessibility of endometrial ligands for Escherichia coli Dr fimbriae.

The mechanisms of developing infection in young, noncompromised individuals are well understood. Colonization is prerequisite for the development of infection. In human, ligands serving bacterial colonization belong to common antigens. Consequently, a majority of individuals should be sensitive to infection at all times. We hypothesize that the temporal patterns of some infections and sensitivity to them are associated with sudden changes in the density and accessibility of common receptors. Endometrial samples from women having normal menstrual cycles were examined for histological location, receptor density, and in situ hybridization of Dr (decaying-accelerating factor) ligands for Escherichia coli Dr fimbriae. Significant up-regulation and luminal expression of Dr ligands occurred during the secretory phase, whereas receptors were expressed in the basement membrane and in smaller quantities during the proliferative phase. This observation agrees with our hypotheses that some ligands recognized by bacterial adhesins change their compartmentalization and, most importantly, that they up-regulate expression at specific times.

Dr fimbriae coding region associated hemolytic activity of Escherichia coli.

We investigated the hemolytic activity of Escherichia coli strain EC901 carrying plasmid pBJN406 containing genes draA-E involved in expression of the mannose-resistant Dr hemagglutinin, and in its isogenic insertion mutants devised with Tn5, Tn3, and TnphoA. While E. coli BN406 displayed rapid hemolytic activity against equine erythrocytes, insertion mutations in draD and draE, but not in draA, draB, and draC, abolished all hemolytic activity. These data suggest a role for draD and draE in the expression of hemolysis.

Quantitative determination of methionine in proteins: gas chromatography of methylthiocyanate liberated by cleavage with cyanogen bromide.

A rapid non hydrolytic method was developed for the estimation of methionine residues in peptides and proteins. The method is based on the gas chromatographic determination of methylthiocyanate liberated in the reaction of cyanogen bromide with the methionine residues. In contrast to the amino acid analyzer technique this method allows selective determination of methionine in the presence of methionine sulphoxide and sulphone. It was tested with both purified proteins and protein-containing crude samples (legume seeds) and was compared with different analyzer techniques.