Hospital management of colonic perforations complicating ambulatory outpatient colonoscopy via over-the-scope clips or surgery: a case series.

BACKGROUND: Colonoscopy is the standard of care for the diagnosis and treatment of many colonic disorders. Over the past few years, endoscopic closure of colonoscopy-related perforation has become more common. Endoscopic closure of perforation secondary to colonoscopy has been undertaken in patients in the hospital setting and often during the same colonoscopic procedure in which the perforation itself occurred. The aim of our study was to analyze our experience with emergency endoscopic closure of colonoscopy-related perforation with over-the-scope clip (OTSC) technique. METHODS: We report five cases of colonic perforation that occurred during colonoscopy in an outpatient facility remotely located from our hospital and then referred as an emergency to our institution for endoscopic closure. RESULTS: Bowel preparation was reported to be adequate in all cases. Prior to attempting endoscopic closure of colonic perforation, all patients were in stable clinical condition, early broad-spectrum antibiotic coverage was initiated, and a surgical consult was obtained. All patients had sigmoidoscopy and were found to have sigmoid colon perforations. In three cases, the perforations were closed successfully using an OTSC clip device 14 mm type t. Two patients were found to have greater than 4-cm sigmoid perforations with irregular margins, incompatible with OTSC closure, and were referred for emergency surgery. All patients had an uneventful course following either OTSC closure or surgery. CONCLUSIONS: Based on the characteristics of the five cases and a review of the literature, we suggest a practical approach for undertaking closure of colonic perforations occurring during colonoscopy in the outpatient setting, focusing on clinical criteria to determine eligibility of patients for attempted endoscopic closure and outlining required therapeutic and monitoring steps needed to optimize outcomes.

PAH fluxes to Siskiwit revisted: trends in fluxes and sources of pyrogenic PAH and perylene constrained via radiocarbon analysis.

Trends in concentrations and radiocarbon content of pyrogenic PAHs and perylene were determined 20 years after a previous study by Mcveety and Hites (1988). Pyrogenic PAH fluxes to sediments were observed to continue to decrease over the period from 1980 to 2000 at this remote site in contrast to observations in more urban areas. Radiocarbon analysis of pyrogenic PAHs showed a 50% decrease in the proportion of pyrogenic PAH derived from fossil fuel combustion over the past 50 years, consistent with decreasing emissions from regional coal-fired power-generating plants. Fluxes of pyrogenic PAHs related to biomass burning were consistent over this same period and found to exceed fossil fuel sources in the most recent samples. Fluxes of biomass-derived pyrogenic PAHs were similar in magnitude to total pyrogenic PAH fluxes in early 1900, suggesting that these fluxes may represent wildfire inputs. Not only did perylene concentrations in these sediments increase with depth as previously observed but also concentrations from the same sedimentary layers analyzed 20 years previously showed large increases in perylene concentrations. Radiocarbon analysis of perylene indicated that 70-85% of perylene observed in the deeper sediments could be explained by production from total organic carbon.

The role of vitamin D in the immunopathogenesis of allergic skin diseases.

Vitamin D plays key roles in innate and adaptive immunity through the stimulation of Toll-like receptors, increasing pro-inflammatory cytokine production, and possibly enhancing T helper type 2 responses. These mechanisms may explain the growing body of evidence connecting vitamin D to allergic diseases, including asthma, food allergies, and allergic rhinitis. The data relating vitamin D to allergic skin diseases are equivocal with studies linking both high and low vitamin D levels to an increased risk of developing atopic dermatitis. In this paper, we describe the role of vitamin D in the immunopathogenesis of atopic dermatitis and other allergic skin diseases.

Is use of temporary pacing wires following coronary bypass surgery really necessary?

AIM: Temporary epicardial pacing wires (TEPW) which are routinely used after coronary bypass grafting may result in significant complications. We sought to identify variables that predict TEPW implantation and thereby limit their use. METHODS: This prospective study enrolled 564 patients (296 underwent coronary artery bypass grafting with cardiopulmonary bypass [ONCAB] and 268 underwent off-pump coronary artery bypass grafting, OPCAB). TEPW were placed in patients with the intraoperative presence of one or more of the following criteria: sinus bradycardia, sinus arrest, nodal/junctional rhythms, atrioventricular block, bundle branch block, ventricular tachycardia, or onset of atrial fibrillation. RESULTS: Only 31 (5.5%) patients [ONCAB: 20 (6.8%) (ventricular: 14, bichamber: 6); OPCAB: 11 (4.1%) (ventricular: 9, bichamber: 2)] had temporary epicardial pacing wires implanted intraoperatively. Indications for using temporary epicardial pacing wires for ONCAB were sinus bradycardia (8), nodal/junctional rhythms (3), atrioventricular block (3), atrial fibrillation (4), and bundle branch block (2), and for OPCAB were sinus bradycardia (8), nodal/junctional rhythms (2), and atrioventricular block (1). Mean duration for pacing was 22.4 h for the ONCAB group and 11.3 h for the OPCAB group. There were no temporary epicardial pacing wires associated complications. One paced OPCAB patient required a permanent pacemaker and 2 non-paced OPCAB patients required transvenous pacing wires. Univariate and multivariate analyses were also conducted to determine risk factors for TEPW. CONCLUSION: TEPW implantation is overused in cardiac surgery and by identifying independent predictors for pacing we conclude that TEPW use should be limited to a select few.

Paving the path.

Fortuitous preparation and experiences led to the opportunity to use radioactive carbon dioxides to discern the path of carbon in photosynthesis. The search for the CO2 acceptor led to recognition of the growth stimulatory effect of methanol and its derivatives. With the techniques developed, radiochromatographic exploration led to discovery of major membrane lipids containing phosphorus, sulfur, and arsenic.

Metabolism of methanol in plant cells. Carbon-13 nuclear magnetic resonance studies.

Using (13)C-NMR, we demonstrate that [(13)C]methanol readily entered sycamore (Acer pseudoplatanus L.) cells to be slowly metabolized to [3-(13)C]serine, [(13)CH(3)]methionine, and [(13)CH(3)]phosphatidylcholine. We conclude that the assimilation of [(13)C]methanol occurs through the formation of (13)CH(3)H(4)Pte-glutamate (Glu)(n) and S-adenosyl-methionine, because feeding plant cells with [3-(13)CH(3)]serine, the direct precursor of (13)CH(2)H(4)Pte-Glu(n), can perfectly mimic [(13)CH(3)]methanol for folate-mediated single-carbon metabolism. On the other hand, the metabolism of [(13)C]methanol in plant cells revealed assimilation of label into a new cellular product that was identified as [(13)CH(3)]methyl-beta-D-glucopyranoside. The de novo synthesis of methyl-beta-D-glucopyranoside induced by methanol did not require the formation of (13)CH(3)H(4)Pte-Glu(n) and was very likely catalyzed by a "transglycosylation" process.

Identification of a new calcitonin gene in the salmon Oncorhynchus gorbuscha.

Three isoforms of calcitonin (CT) exist in salmonids. Isohormones I and II are expressed in the pink salmon Oncorhynchus gorbuscha. We report here the existence in this species of a CT gene and of its transcripts, which encode for a fourth isohormone, the salmon CT (sCT) IV. This new CT gene was identified by PCR from genomic DNA and by sequencing the amplified DNA. The expression of this CT gene was established in ultimobranchial body and brain, by reverse transcription-PCR, hybridization and sequencing. The sCT IV gene, like the sCT I gene, is a complex transcription unit, containing exons encoding for a CT as a calcitonin gene-related peptide (CGRP) molecule. The predicted peptide, sCT IV, has a greater homology with the eel CT and the sCT II than with the sCT I. Alignment of the sCT IV with other fish and chicken CT showed amino acid modifications in similar positions as those found during evolution. The predicted salmon CGRP IV peptide is highly homologous to the known CGRP molecules in other species, confirming the high conservation of the molecule during evolution. This identification of a new salmon CT gene is interesting both for the therapeutic potential represented by the new molecules encoded by this gene and for phylogenetic studies.

The calcitonin gene is expressed in salmon gills.

Calcitonin is an important physiological regulator of salmon gills. Although the calcitonin receptor was found in salmon gills, the critical question concerning the source of the hormone remained unanswered. In this communication, evidence is presented for expression of calcitonin mRNA and its encoded peptide in gills of the pink salmon, Oncorhynchus gorbuscha. The expression of calcitonin gene transcripts was demonstrated by reverse transcription-polymerase chain reaction, Southern hybridization, and sequencing. The sequencing identified a sequence corresponding to that of exon 4 of the salmon calcitonin gene. Expression of the encoded calcitonin gene in gills was detected by radioimmunoassay in gill extracts. This synthesis of calcitonin in gills, which also possess specific receptors to the peptide, suggests function of an autocrine or paracrine process producing calcitonin in this tissue. These observations confirm and extend previous reports on the physiological role of calcitonin in fish gills.

Expression of CGRP mRNAs in the pink salmon, Oncorhynchus gorbuscha.

We report the isolation of calcitonin gene-related peptide (CGRP) mRNAs and expression of these RNAs in different tissues in the pink salmon, Oncorhynchus gorbuscha. Hybridization of poly(A+) RNAs indicated a mature CGRP RNA of 1.1 kb. The CGRP-like immunoreactivity occurring in tissues and plasma had the same relative molecular weight as the synthetic molecule. Variations in CGRP plasma levels were observed during migration, spawning, and postspawning states. These data suggest that CGRP may play an important role during the reproductive cycle of salmon.

The path of carbon in photosynthesis: improved crop yields with methanol.

Foliar sprays of aqueous 10-50% methanol increased growth and development of C3 crop plants in arid environments. The effects of low levels (< 1 ml per plant) of methanol were observed for weeks after the brief time necessary for its rapid metabolism. Within several hours, foliar treatment with methanol resulted in increased turgidity. Plants treated with nutrient-supplemented methanol showed up to 100% increases in yields when maintained under direct sunlight in desert agriculture. In the shade and when winter crops were treated with methanol, plants showed no improvement of growth. When repeatedly treated with nutrient-supplemented methanol, shaded plants showed symptoms of toxicity. Repeated methanol treatments with glycine caused increased turgidity and stimulated plant growth without injury under indirect sunlight, but indoors with artificial illumination, foliar damage developed after 48 hr. Addition of glycerophosphate to glycine/methanol solutions allowed treatment of artificially illuminated plants indoors without injury. Plants with C4 metabolism showed no increase in productivity by methanol treatment. Plants given many applications of aqueous methanol showed symptoms of nutrient deficiency. Supplementation with a source of nitrogen sustained growth, eliminating symptoms of deficiency. Adjustment of carbon/nitrogen ratios was undertaken in the field by decreasing the source of nitrogen in the final application, resulting in early maturation; concomitantly, irrigation requirements were reduced.

The gill lipids of spawning Pacific salmon.

The gill phospholipids of 2 Pacific salmon species, Oncorhynchus keta and O gorbuscha, were composed of 38-43% phosphatidylcholine (PC) and 19-22% phosphatidylethanolamine (PE). Ether phosphoglycerides constituted 4-8% of the total PC fraction and 37-51% of the PE fraction. No significant changes in gill phospholipids were observed between those of pre-spawning fish in sea water and those of spawned salmon in the river. Cholesterol, however, was higher in the latter (0.59% vs 0.38%).

Arsonium compounds in algae.

Search for a precursor of the arsenobetaine discovered in Western Australian rock lobster tail muscle has led to an algal metabolite of radioarsenate having the properties of a trimethylarsoniumriboside derivative of the major arsenicals of aquatic plants, dimethylarsinoylribosylglycerol, its sulfate ester, and the corresponding riboside of phosphatidylglycerol. Such an arsonium compound could serve as metabolic precursor of arsenobetaine, the innocuous arsenical component of many marine food products. The oceanic diatom, Chaetoceros gracilis, cultured in radioarsenate produced a compound whose chemical, chromatographic, and electrophoretic properties are described. It was found to be identical to the trimethylarsonium derivative synthesized from the major algal arsenical, 1-(5'-dimethylarsinoyl-5'-deoxyribosyl)glycerol-3-O -sulfate.

Calcium-regulating hormones modulate carbonic anhydrase II in the human erythrocyte.

The effect of calcitonin (CT) and parathyroid hormone (PTH) on carbonic anhydrase (carbonate hydrolyase, EC 4.2.1.1.) activity was tested in human erythrocyte hemolysates and with purified carbonic anhydrases I and II. The most important effect was on carbonic anhydrase II: CT showed a 2-fold increase and PTH showed a 50% decrease of carbonic anhydrase activity. This effect was observed at low hormonal concentrations and suggests the importance of CT in regulating carbonic anhydrase activity in the two important sites of CO2 exchange, erythrocyte and lung.

Plasmalogens in the gill lipids of aquatic animals.

Lipids constituted 0.6-2.2% wet wt of the gills of 11 species of aquatic animals (4 bivalves, a crustacean and 6 fishes). Phospholipids, largely phosphatidylcholine (PC) and phosphatidylethanolamine (PE), are major components of all species. The plasmalogen contents of these lipids were 47-291 mumol/g, with the highest values found for bivalve gill total lipids and the catfish phospholipid fraction.