Routine splenic flexure mobilization may increase compliance with pathological quality metrics in patients undergoing low anterior resection.

AIM: Mandatory splenic flexure mobilization (SFM) has been debated for rectal cancers. Proponents argue that additional mobilization facilitates a tension-free anastomosis; however, this must be weighed against heightened morbidity. Little is known about the impact of specific techniques on pathology quality metrics. We aim to determine the impact of SFM on pathology quality metrics for patients undergoing rectal resections for colorectal adenocarcinoma. METHOD: Patients were selected by querying the University of Kansas electronic medical records and the American College of Surgeons National Surgical Quality Improvement Program database based on Current Procedural Terminology codes. Patients were categorized as SFM or non-SFM. Primary outcomes were node yield less than 12 and margin length. RESULTS: There were 146 patients who met the inclusion criteria for chart review and 7369 included from the national database. Splenic flexure mobilization was associated with wider margins (3.52 vs 2.51 cm in low anterior resection, P < 0.01) and a decreased rate of inadequate nodal staging in patients undergoing low anterior resection (3.7% vs 19.3% P < 0.01). CONCLUSIONS: SFM may affect surgical quality metrics in patients undergoing resection for distal colon and rectal adenocarcinoma. Further study is warranted to determine whether these differences in quality and pathology translate into differences in oncological outcomes.

Permeability of model stratum corneum lipid membrane measured using quartz crystal microbalance.

The stratum corneum (SC) is the outermost layer of the epidermis. Stacked intercellular lipid membranes found in the SC play a crucial role in regulating water transport through the skin. Despite the importance of this role of the SC lipid membranes, only a few studies have presented quantitative methods to measure the permeability of water in SC lipid membranes. In this work, we present a new method to determine the water permeability of a model SC lipid membrane using a quartz crystal microbalance (QCM). We investigate a model SC lipid membrane comprising an equimolar mixture of brain ceramide (CER), cholesterol (CHO), and palmitic acid (PA), and use QCM to determine the diffusivity (D), solubility (S,) and permeability (P) of water vapor in the model SC lipid membrane.

Effects of fungicides on thyroid function, metabolism, and thermoregulation in cotton rats.

Among the myriad of recent studies on endocrine-disrupting chemicals, relatively few involve thyroid disruption, and most of these address exposure/disruption during embryonic life. Of those involving adult vertebrates, the endpoints examined are thyroid measurements. Even though thyroid disruption could potentially interfere with energy metabolism and thermoregulation such that over-winter survival might be compromised, the possible energetic consequences of these thyroid perturbations have not been investigated. We assessed thyroid function and measured resting metabolic rates of cotton rats chronically exposed to the fungicides vinclozolin or mancozeb. In addition, we measured norepinephrine-induced nonshivering thermogenesis and cold-induced thermogenesis and then cold-acclimated the mancozeb animals. Although thyroid hormone concentrations generally decreased, this was compensated for by an increase in thyroxine turnover (vinclozolin study only) such that thyroxine utilization rate was not different. In addition, there was no difference between the treated and control animals in any of the metabolic parameters measured. It is concluded that wild rodents exposed to these compounds are not energetically compromised.

Effects of in vivo cocaine administration on human platelet aggregation.

To evaluate whether cocaine administration to human volunteers in vivo increases platelet aggregation, 12 healthy male volunteers were studied twice in a prospective, double-blinded fashion. There was a decrease in aggregation following cocaine exposure compared to placebo, which was most prominent at high doses of adenosine diphosphate.

Effects of cocaine on human platelet aggregation in vitro.

BACKGROUND: A temporal relationship has been established between cocaine ingestion and myocardial infarction, and a cocaine-induced increase in platelet aggregation has been suggested as a possible explanation. However, the mechanisms of cocaine associated coronary thrombosis have yet to be completely elucidated. For this reason, we examined the in vitro effect of cocaine and its metabolites on platelet aggregation. METHODS: Platelet aggregation was tested by obtaining platelet rich plasma from 42 healthy volunteers and incubating the platelet rich plasma in six concentrations of cocaine (ranging from 1.47 to 2940 nmol) for 10 minutes prior to aggregation with ADP 1 microM. The same procedure was used to test the effect of two cocaine metabolites, benzoylecgonine and ecgonine methyl ester, on platelet aggregation. Abnormal results were confirmed by inducing aggregation with ADP at higher concentrations (2.4 and 10 microM) and with arachidonic acid (624 microM). RESULTS: At increasing concentrations, cocaine progressively inhibited ADP and arachidonic acid induced platelet aggregation. No effect was seen with benzoyl ecgonine or ecgonine methyl ester as compared to saline. CONCLUSIONS: These data suggest that under certain conditions cocaine may negatively affect hemostasis by decreasing platelet aggregation.

Evaluation of a modified procedure for Staclot LA for the confirmation of lupus anticoagulants.

Staclot LA is a hexagonal (II) phase phospholipid clotting assay used to confirm the presence of lupus anticoagulants (LA). However, there have been complaints that the procedure contains several incubation steps requiring 15 min of operator time. The authors were able to shorten this procedure to a single 5 min incubation without affecting assay sensitivity. Both procedures were performed on 45 known lupus anticoagulant positive specimens, 25 normal donors, eleven plasmas from patients with known factor VIII or factor V inhibitors and ten other specimens submitted for lupus anticoagulant or anticardiolipin antibody testing but without complete testing to confirm the presence of LA prior to testing with Staclot LA. Excellent agreement was observed between the two procedures with concurrence in 87 of 91 specimens (95.6%). Each method detected 39 of 45 LA positive specimens giving a sensitivity of 86.7%. This modification shortens technologist time by two-thirds without compromising assay sensitivity, which will allow for automation on commonly used coagulation analysers.

Hypoprothrombinemia and severe hemorrhage associated with a lupus anticoagulant.

We recently encountered a previously healthy 3-year-old girl who had severe bleeding resulting from a severe deficiency of prothrombin. A lupus anticoagulant was identified by several different methods. The patient was successfully treated with glucocorticoids. This rare complication of a lupus anticoagulant should be considered in the differential diagnosis of a previously well child who suddenly has hemorrhage.

Complementation in Zellweger syndrome: biochemical analysis of newly generated peroxisomes.

The Zellweger syndrome is characterized by a defect which results in the abnormal biogenesis of peroxisomes. As a consequence, metabolic activities associated with peroxisomes such as the oxidation of very long chain fatty acids, the synthesis of plasmalogens, and the catabolism of phytanic and pipecolic acids are impaired. Since this disorder is genetically heterogeneous and several complementation groups are known, we were able to study the normalization of peroxisomal activity during the process of complementation. The restoration of catalase and dihydroxyacetone phosphate acyltransferase activities peaked within 3-4 days postfusion while the oxidation of lignoceric acid was much delayed (7-8 days). Electron microscopy indicated that by 6 days following hybridization, peroxisome structure and density in heterokaryons was comparable to normal control cells. The heterogenous biochemical response during peroxisome normalization could be due to several factors including a possible requirement for restoration of peroxisomal structural integrity for maximum activation of certain metabolic pathways.