Keratinocyte growth factor enhances early gut adaptation in a rat model of short bowel syndrome.

OBJECTIVE: To evaluate the effects of keratinocyte growth factor (KGF) on intestinal adaptation after resection of 85% of the small intestine and consider its potential application in short bowel syndrome (SBS). STUDY DESIGN: Experimental study using a known model of SBS. ANIMAL POPULATION: Thirty male Sprague Dawley rats. METHODS: Four groups of animals were designated. Two groups underwent 85% resection of the small intestine, while the other two groups were sham-operated, undergoing transection and reanastomosis. Resected and sham-operated groups then received either 3 mg/kg KGF or vehicle subcutaneously daily for 3 days. Gut adaptation was evaluated by measurements of mucosal cellularity and biochemical activity in duodenal, jejunal, and ileal segments. RESULTS: Significant small intestinal growth after bowel resection alone was confirmed in resected versus sham-operated rats. KGF further augmented this growth in the resected animals. Mucosal wet weight of the small intestine increased with resection and was further increased (by 20% or more) with KGF administration. Mucosal thickness, villus length, and crypt depth exhibited similar patterns of response. The KGF-induced increase in mucosal morphology was accompanied by increased mucosal DNA and protein content, followed by a trend toward increased mucosal enzyme activity. Histology demonstrated an increase in goblet cells in KGF-treated animals. In situ hybridization analysis demonstrated that KGF markedly increased mucosal expression of intestinal trefoil protein (ITF) mRNA. CONCLUSIONS: KGF enhances gut growth, differentiation, and gene regulation during adaptation in rat small intestine after massive resection. CLINICAL RELEVANCE: KGF may be beneficial in the management of veterinary and human patients undergoing massive intestinal resection.

Effect of a pharmacy-based cost-containment program on cimetidine costs and use.

A program developed by the University of California at San Diego Medical Center to curb over-prescribing of cimetidine is described. Guidelines for cimetidine use were approved in September 1985. Pharmacists undertook physician education and enforced the guidelines by monitoring patients through a specially designed documentation form. When use of cimetidine was not in compliance with the guidelines, the pharmacists contacted the physicians to recommend changes. Use of cimetidine hydrochloride injection declined 49% between September 30 and December 6, 1985. Extrapolated to an entire year, this reduction would result in cost savings of +12,000 to +16,000. However, after pharmacists stopped enforcing the guidelines in December 1985, use of cimetidine hydrochloride injection gradually increased to near control levels. In February 1986, the review of patients receiving cimetidine was reinstituted, resulting in another decline in use. Periodic review and reinforcement by pharmacists appear necessary to ensure that cimetidine continues to be prescribed appropriately.

Development of a simple device for processing whole-blood samples into measured aliquots of plasma.

A capillary processor and aliquoter has been designed and fabricated that is capable of accepting aliquots of whole blood and automatically processing them into discrete aliquots of plasma. The device consists of two disks, each of which contains 16 individual capillaries and a processing rotor. One disk accepts larger capillaries that hold approximately 100 microL of whole blood each. The second disk accepts 2.54-cm-long precision capillaries of various internal diameters, which provide exact sample volumes from 1 to 10 microL. The processing rotor contains 16 individual compartments and chambers to accept both disks. Applying centrifugal force transfers the aliquots of whole blood into their respective compartments, where they are separated into cellular and plasma fractions. As the rotor speed is slowly decreased, an aliquot of plasma is withdrawn by capillary action into each measuring capillary. The disk containing the 16 measured aliquots of plasma is then removed and placed into a modified rotor for conventional centrifugal analysis. This device can entrain and deliver microliter volumes of liquids with precision and accuracy (1-2%) near that of mechanical pipettes. Assays of the separated plasma aliquots also have acceptable precision (e.g., CVs approximately 3% for measurements of serum enzymes).

Recognition of emotion from vocal cues.

In two studies investigating the recognition of emotion from vocal cues, each of four emotions (joy, sadness, anger, and fear) was posed by an actress speaking the same, semantically neutral sentence. Judgments of emotion expressed in these segments were compared with similar judgments of voice-synthesized (Moog synthesizer) samples (study 1) or with three different alterations of the full-speech mode (study 2). Correct identification of the posed emotion was high in the full-speech samples. Voice-synthesized samples seemed to capture some cues promoting emotion recognition, but correct identification did not approach that of other segments. Recognition of emotion decreased, but not as dramatically as expected in each of the three alterations of the original samples.

Percutaneous ultrasonic disintegration and removal of renal calculi.

We report the first use in Australia of the technique of percutaneous ultrasonic disintegration and removal of renal calculi. The first three patients who underwent the procedure had a successful outcome. These three patients are described, the method is detailed and the problems which were encountered are discussed.

Automated system for fractionation of blood samples.

We describe a prototype system for preparing multiple fractions of blood components (plasma, washed erythrocytes, and hemolysates) by use of automated techniques. The procedure is based on centrifugal separation and sample transfer by induced pressure differentials in a blood-processing vessel (rotor) that has been designed to process 24 samples simultaneously. Erythrocytes are sedimented against the outer walls of individual sample chambers, and plasma is siphoned, by imposition of either a slight positive or negative pressure, into individual reservoirs in a collection ring. Cells are washed in situ; samples of washed cells, either packed or in saline solution, can be recovered. Cellular hemolysates are automatically prepared and transferred to individual, commercially available collection vials, ready for immediate analysis or for storage in liquid nitrogen. The system has potential application in any biomedical area in which many samples are to be expeditiously analyzed and in which one or more of the blood fractions will be used. A separate unit has been designed and developed for the semiautomated cleaning of the rotor.

Removal of foreign bodies: the flexible fiberoptic endoscope.

Three foreign bodies were successfully removed from the upper gastrointestinal tract with a fiberoptic endoscope. They included a food bolus lodged above an esophageal stricture, a metallic nebulizer tip impacted in the mid-esophagus, and a spoon lodged in the stomach. A razor blade could not be removed from the duodenum. Many foreign bodies, including large or elongated objects, can be removed from the upper gastrointestinal tract with flexible fiberoptic endoscopes.

Development of a multipurpose optical system for use with a centrifugal fast analyzer.

A Centrifugal Fast Analyzer is basically a sophisticated photometric measuring device containing a multicuvet rotor as its major component. Several reactions are simultaneously initiated in the rotor, which is then rotated through a stationary optical monitor and the resulting signals acquired and processed by an on-line data system. ?With the miniature version of this analyzer, one has the option of directing the incident optical beam, via a fiber optical bundle, into the cuvets of the spinning rotor in either a 90 degrees or a 180 degrees orientation relative to the analyzer's photodetector. tthe combination of newly designed rotors and a flexible optical system having multiple configurations has provided a versatile system in which one can measure the transmittance, fluorescence, chemiluminescence, or light-scattering (either turbidimetrically or nephelometrically) properties of the ensuing reaction species, all with a single analyzer. This flexibility in choosing the optical mode in which a particular set of reactions is to be monitored provides the analyst with a powerful and versatile analytical tool for developing new methods for use in various clinical laboratory applications, including chemistry, toxicology, immunology, and hematology.