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Notes: Abstract Fecal mass and electrolyte concentrations from 25 ileectomy and/or colectomy patients on known diets were used to assess those factors most responsible for their diarrhea. In 18 ileectomy patients the severity of diarrhea, expressed as a fecal weight, was a function of both percent of colon and centimeters of ileum removed. Linear regression analysis, however, showed that the extent of missing colon had three times the effect of missing ileum on fecal weight. Patients who lost the ileocecal valve and part of the right colon had more diarrhea than those who lost comparable lengths of ileum but had this area preserved. Fecal ion concentrations seemed independent of diet but were related to fecal weight and the amount of colon and ileum removed. Potassium concentration was strongly dependent on the amount of colon lost, while sodium concentration was more influenced by the length of resected ileum. Chloride was most dependent on fecal weight. As expected, fecal fat correlated strongly with the extent of ileum removed. Regression equations were constructed from the electrolyte data which described and predicted the extent of lost ileum or colon. Our data were also used to separate patients with less than 100 cm of ileum removed from those with more extensive resections. The severity of diarrhea following ileal resection depends primarily on the amount of contiguous colon removed. Varying loss of ileum and colon produced predictable effects on fecal weight and electrolyte composition. Surgeons should preserve the maximum amount of colon possible to reduce the severity of diarrhea in these patients.

Notes: Zusammenfassung Bei einem Teil der Patienten mit nichtischämischer Herzinsuffizienz werden entzündliche Veränderungen im Herzmuskelgewebe beobachtet, die für die Entwicklung einer Herzinsuffizienz ursächlich oder pathogenetisch von Bedeutung sein können. Das interzelluläre und das vaskuläre Adhäsionsmolekül-1 (ICAM-1,VCAM-1) stellen Membranproteine mit Rezeptorfunktion aus der Immunglobulin-Superfamilie dar, die als Marker für eine ablaufende Entzündungsreaktion bei verschiedenen entzündlichen Erkrankungen gelten. Ziel der vorliegenden Studie war es, das Vorkommen von zirkulierenden Formen von ICAM-1 und VCAM-1 bei 71 Patienten mit nichtischämisch bedingter Herzinsuffizienz (47 M/24 F, mittl. Alter: 55 ± 11 Jahre) in Abhängigkeit von hämodynamischen und myokardbioptischen Befunden zu untersuchen. Methode: Serumkonzentrationen von cICAM-1 und cVCAM-1 wurden mittels ELISA-Kits bestimmt. Die Einteilung des Schweregrades der Herzinsuffizienz erfolgte nach der NYHA-Klassifikation und nach hämodynamischen Parametern (Pulmonalarterienmitteldruck, linksventrikuläre Ejektionsfraktion). Die Erfassung entzündlicher Veränderungen im Herzmuskelgewebe erfolgte histologisch und immunhistologisch (mittlere T-Lymphozyten ≥ 7,0 mm2, Expression der HLA-Antigene der Klasse I und II) an rechtsventrikulär entnommenen Myokardbiopsien. Als Kontrollen galten 16 altersentsprechende Patienten mit global normaler LV-Funktion (8 M/8 F, mittl. Alter 55 ± 6 Jahre, mittlere Ejektionsfraktion 76 ± 3%) ohne entzündliche Veränderungen in der Myokardbiopsie (mittlere T-Lymphozyten 〈 3,5 Zellen/mm2, geringe HLA-Expression).Ergebnisse: Die mittleren Serumkonzentrationen für cICAM-1 und cVCAM-1 waren bei Patienten mit nichtischämisch bedingter Herzinsuffizienz (372 ± 107 ng/ml und 949 ± 439 ng/ml) höher als mit Kontrollkollektiv (264 ± 37 und 710 ± 164 ng/ml) (p 〈 0,05). Hämodynamisch schwach positiv korrelierte der mittlere Pulmonalarteriendruck und invers die linksventrikuläre Ejektionsfrakation mit beiden löslichen Formen der Adhäsionsmoleküle (für cICAM-1; Pearson's r: 0,24 und –0,33; für cVCAM-1: Pearson's r: 0,28 und –0,26, p 〈 0,05) Myokardbioptisch wiesen 38% der Patienten (n = 16) mit erhöhten Konzentrationen von cICAM-1 (≥ 337 ng/ml) und 41% (n = 7) mit erhöhten Serumspiegeln für cVCAM-1 (≥ 1038 ng/ml) erhöhte T-Lymphozyten (im Mittel: 7 bis 22 Zellen/mm 2) und eine verstärkte Expression der Histokompatibilitätsantigene der Klasse I/II im Herzmuskelgewebe auf (p 〈0,05). Bei mehr als 9,3 T-Lymphozyten pro mm2 im Myokard (n = 7) waren signifikant höhere Serumkonzentrationen für cICAM-1 (447 ± 146 ng/ml, p 〈 0,05 gegenüber Kontrollen) und für cVCAM-1 (1577 ± 688 ng/ml, p 〈 0,001) zu messen. Beide Adhäsionsmoleküle korrelierten signifikant mit der mittleren Anzahl von T-Lymphozyten im Herzmuskelgewebe ( Pearson's r: 0,31–0,37, p 〈 0,05). Zusammenfassung und Schlußfolgerung: Die vorliegende Studie zeigt, daß bei Patienten mit nichischämisch bedingter Herzinsuffizienz häufig erhöhte Serumkonzentrationen von cVCAM-1 und cICAM-1 nachweisbar sind. Diese korrelieren mit hämodynamischen Zeichen der Herzinsuffizienz und sind bei Patienten mit entzündlichen Infiltraten im Herzmuskelgewebe bsonders deutlich erhöht. Dies deutet auf einen Zusammenhang zwischen Herzinsuffizienz und entzündlichen Veränderungen im Myokard hin.

Notes: Abstract A microcrystalline collagen hemostat (MCH) widely used in general surgery was tested in the control of bleeding from experimentally produced gastric ulcers. Five dogs had a gastrotomy and were given heparin. Using the standard “ulcer maker,” three sets of three ulcers were made in the gastric mucosa of each animal. Blood from each ulcer was collected for a 5-min period to allow for stabilization of bleeding. MCH powder or slurry or no MCH was placed directly on one ulcer of each set in random order. The bleeding rate for the next 10 min was measured. Mean decrements in the bleeding rate for slurry MCH and dry MCH-treated ulcers were 87% and 81%, respectively, compared with 51% for controls,P〈0.05. Twelve MCH-treated ulcers, but no control ulcer, stopped bleeding completely,P〈0.01. Preliminary observations show that MCH slurry can be applied through an endoscope and may be hemostatically effective in man. MCH may have a role in the endoscopic control of gastrointestinal bleeding.

Notes: Abstract To determine if organic anions contribute to the diarrhea of inflammatory bowel disease, we measured osmolality, electrolytes, short-chain fatty acids, lactic acid, and some Krebs cycle anions in 24-hr fecal collections from 18 patients with chronic ulcerative colitis, 20 with Crohn's disease of the colon, and 16 normals. Mean lactic acid concentration was significantly elevated in ulcerative and Crohn's colitis, but values correlated with fecal weight only in the former syndrome. In ulcerative colitis, concentrations of each short-chain fatty acid, especially butyrate, were decreased compared with those from normals or Crohn's disease. Lactate and short-chain fatty acids accounted for nearly half the variability in fecal weight in ulcerative colitis. Crohn's patients had elevated mean fecal water osmolality and osmotic gap not observed in ulcerative colitis. Increased lactic acid and/or deficient short-chain fatty acids may modulate the diarrhea of ulcerative colitis. This mechanism seems less important in Crohn's colitis where an additional osmotic component may be significant.

Notes: Forty-nine 12-week-old male Syrian golden hamsters (Mesocricetus auratus), weighing 108 to 128 g, were injected i. p. with [3H]-thymidine (3HTdR 2 μCi/g body wt). Animals were divided into 7 weight-matched groups and were killed at 1 hour (day zero) and 1, 2, 3, 4, 7, and 14 days after thymidine injection. Lungs were fixed by vascular perfusion of 4% formalin/1% glutaraldehyde in 0.2 M cacodylate buffer at pH 7.4, cut at 2 μm, dipped in Kodak NTB3 or NTB2 nuclear emulsion, exposed for 2 weeks, developed and stained. In each airway cross-section, total epithelial and fibroblast counts and labeled cell count were estimated. A cell was considered labeled when 3 or more silver grains appeared on its nucleus. The background grain count was less than 1 grain per nucleus.Mean epithelial and fibroblast cell density in a 100 μm segment were respectively 14.8 ± 0.1 and 6.6 ± 0.1 cells (the second number is one standard error of the mean). One hour after labeling, their respective labeling indices (L. I.) were 0.13 ± 0.02 and 1.24 ± 0.1. On day 1, their L. I. doubled and then returned to the initial value. One hour after labeling, epithelial and fibroblast mean grain counts did not differ significantly. They were respectively 20.6 + 1, and 15.8 ± 2. Because grain count intensity is closely related to DNA synthetic time, it seems plausible that epithelial and fibroblast synthetic times do not differ much. Cell turnover and cell cycle times were estimated from grain count dilution curves. The respective loggrain dilution slopes, -0.025 ± 0.005 and -0.044 ± 0.014 do not differ significatly when tested by t-test. It is concluded, therefore, that both cell types turn over at the same rate with an estimated cell cycle time of 20 days. © 1992 Wiley-Liss, Inc.