Removal of GIT lesions and the role of impedance of the injection solution-an innovative approach to known methods.

In this work, for the first time, the specific impedances of various injection solutions as well as the surface and tissue impedance after injection of these solutions were analyzed and compared regarding the radio-frequency surgical cutting process. The impedances of 0.9% NaCl, 4% gelatine, 6% hydroxyethyl starch, 10% glycerol/5% fructose, 10% glucose, 5% and 20% albumin, blood, and blood plasma as well as aqua destillata have been tested in vitro. Even if EMR and ESD are routinely used in clinical practice, there is so far no easy, fast, and safe method to remove larger lesions en bloc. We show that the impedance of the injected solution shows to be a crucial factor for safe removal, especially of larger lesions (Ø > 20 mm) and more importantly in accordance with the requirements of oncology and pathology. KEY MESSAGES: Impedance is playing a crucial factor in the radio-frequency (RF)-surgery. With a higher Impedance there will be less current necessary to reach the aimed voltage. Injection solution Aqua destillata and 10% Glucose, show significantly higher Impedances. Higher impedances lead to less surgical related complications. Minor changes in existing method to improve patent safety.

Optimised endoscopic access for intrajejunal levodopa application in idiopathic Parkinson's syndrome.

Pump-guided intrajejunal levodopa administration is one of the indispensable forms of therapy in advanced Parkinson's syndrome, along with deep brain stimulation and subcutaneous apomorphine injection. The standard application of levodopa gel via a JET-PEG, i.e. a percutaneous endoscopic gastrostomy (PEG) with an inserted internal catheter into the jejunum, has not been unproblematic due to the restricted absorption area of the drug in the region of the flexura duodenojejunalis and especially due to the sometimes considerable accumulated complication rates of a JET-PEG. Causes of complications are mainly a non-optimal application technique of PEG and internal catheter as well as the often missing adequate follow-up care. This article presents the details of a-compared to the conventional technique-modified and optimised application technique, which has been clinically proven successfully for years. However, many details derived from anatomical, physiological, surgical and endoscopic aspects must be strictly observed during the application to reduce or avoid minor and major complications. Local infections and buried bumper syndrome cause particular problems. The relatively frequent dislocations of the internal catheter (which can ultimately be avoided by clip-fixing the catheter tip) also prove to be particularly troublesome. Finally, using the Hybrid technique, a new combination of an endoscopically controlled gastropexy with 3 sutures and subsequent central thread pull-through (TPT) of the PEG tube, the complication rate can be dramatically reduced and thus a decisive improvement achieved for patients. The aspects discussed here are highly relevant for all those involved in the therapy of advanced Parkinson's syndrome.

Learning of flexible endoscopy, particularly endoscopic vacuum therapy (EVT).

BACKGROUND: Anastomotic insufficiency and perforations in the gastrointestinal tract are severe complications associated with a high complication rate and mortality. Conventional treatment options (particularly re-operations) are often unsatisfactory. Endoscopic vacuum therapy (EVT) is increasingly being used as a promising alternative. PROBLEM: The use of EVT requires a high level of competence in interventional flexible endoscopy, which is primarily not available to every surgeon. Special training programs are required here. METHODS: Based on this need the long-proven Tuebingen training system for flexible endoscopy was modified to meet the special requirements of surgeons and is currently being extended by a special training module for EVT. RESULTS: In addition to the theoretical principles, the training is focused on learning the manual skills for flexible endoscopy. A 2-stage process was developed for this purpose: 1) to become familiar with handling of the flexible endoscope and to learn spatial orientation by means of a didactically optimized abstract phantom ("Tuebingen Orientophant") and 2) learning and training of EVT using a newly developed patient-analogous training model with various insufficiencies and abscess cavities in the upper and lower gastrointestinal tract ("Tuebinger Spongiophant"). The procedure can be trained hands-on step by step exactly as with the patient, whereby the sponge can be applied using different methods, such as overtube and dragging procedures. The consequences of mistakes and complication management can also ideally be trained hands-on using the phantom. DISCUSSION: Evaluations of the first course series show that surgeons achieve endoscopic competence very quickly and learn to master the new procedure. The structure of such a course must, however, be designed according to long-term experience in an optimal didactic manner. Decision-makers in healthcare policy should give much more support to such courses in order to improve patient care and to increase patient safety.

[Learning of flexible endoscopy, particularly endoscopic vacuum therapy (EVT)]. / Erlernen der flexiblen Endoskopie, insbesondere der endoskopischen Vakuumtherapie (EVT).

BACKGROUND: Anastomotic insufficiency and perforations in the gastrointestinal tract are severe complications associated with a high complication rate and mortality. Conventional treatment options (particularly re-operations) are often unsatisfactory. Endoscopic vacuum therapy (EVT) is increasingly being used as a promising alternative. PROBLEM: The use of EVT requires a high level of competence in interventional flexible endoscopy, which is primarily not available to every surgeon. Special training programs are required here. METHODS: Based on this need the long-proven Tübingen training system for flexible endoscopy was modified to meet the special requirements of surgeons and is currently being extended by a special training module for EVT. RESULTS: In addition to the theoretical principles, the training is focused on learning the manual skills for flexible endoscopy. A 2-stage process was developed for this purpose: 1) to become familiar with handling of the flexible endoscope and to learn spatial orientation by means of a didactically optimized abstract phantom (Tübingen Orientophant) and 2) learning and training of EVT using a newly developed patient-analogous training model with various insufficiencies and abscess cavities in the upper and lower gastrointestinal tract. The procedure can be trained hands-on step by step exactly as with the patient, whereby the sponge can be applied using different methods, such as overtube and dragging procedures. The consequences of mistakes and complication management can also ideally be trained hands-on using the phantom. DISCUSSION: Evaluations of the first course series show that surgeons achieve endoscopic competence very quickly and learn to master the new procedure. The structure of such a course must, however, be designed according to long-term experience in an optimal didactic manner. Decision-makers in healthcare policy should give much more support to such courses in order to improve patient care and to increase patient safety.

pH-dependent cytotoxic effects of extracts of the marine sponge Polymastia janeirensis on cancer cell lines.

The purpose of this work was to study the cytotoxic effects of marine sponge Polymastia janeirensis, which has been observed in the field to release an orange substance that is toxic to fish. The result showed that aqueous extract (pH 7.0) was highly cytotoxic to glioma (U87) and neuroblastoma (SHSY5Y) cancer cell lines (IC50 < 1.0 µg/mL). In addition, this extract showed potent antioxidant and procoagulant (decreased the clotting time by 1.7-fold) activities. Interestingly, the cytotoxic effects were pH-dependent since the viability of the cancer cells was not affected with the extract (pH 5.5). The close similarity between the aqueous extract (pH 7.0) and the orange liquid that is released by the sponge indicates that this potential chemical defence of P. janeirensis deserves further investigation.

Antibiofilm activity of Cobetia marina filtrate upon Staphylococcus epidermidis catheter-related isolates

We report the antibiofilm activity by the sponge-associated bacterium Cobetia marina upon Staphylococcus epidermidis clinical isolates obtained from central venous catheters. Antibiofilm activity/antimicrobial susceptibility correlation might predict the action of the metabolite(s) upon Staphylococcus epidermidis in the clinic, making it a possible adjuvant in therapies against biofilm-associated infections.

Antibiofilm activity of Cobetia marina filtrate upon Staphylococcus epidermidis catheter-related isolates.

We report the antibiofilm activity by the sponge-associated bacterium Cobetia marina upon Staphylococcus epidermidis clinical isolates obtained from central venous catheters. Antibiofilm activity/antimicrobial susceptibility correlation might predict the action of the metabolite(s) upon Staphylococcus epidermidis in the clinic, making it a possible adjuvant in therapies against biofilm-associated infections.

Detecção de atividade lectínica e atividade hemolítica em extratos de esponjas (Porifera) nativas da costa atlântica do Brasil / Detection of lectinic activity and hemolytic activity in extracts of native sponges (Porifera) of atlantic coast of Brazil

Extratos aquosos de vinte espécies de esponjas da costa Atlântica brasileira foram testados para verificação da presença de atividade lectínica e atividade hemolítica. Hemaglutinação para eritrócitos humanos e de distintos animais foi evidenciada em 12 dos 20 extratos testados. Os extratos das espécies Axinella corrugata, Chondrilla nucula, Chondrosia collectrix, Cinachyrella alloclada e Guitarra sp1. foram os que apresentaram maior atividade hemaglutinante. Dos doze extratos com atividade hemaglutinante dez tiveram a atividade inibida por um ou mais açúcares e/ou glicoproteínas. A lectina do extrato de Chondrilla nucula foi resistente à desnaturação térmica quando aquecida a 100 ºC por 60 minutos. Atividade hemolítica foi encontrada apenas nos extratos de Petromica citrina e Acervochalina sp. As espécies que apresentaram maior potencial para futuros estudos de suas lectinas foram Axinella corrugata, Chondrilla nucula e Chondrosia collectrix, em vista da maior atividade hemaglutinante apresentada por seus extratos, aliada à maior atividade específica.

Aqueous extracts of twenty species of sea sponges of the Brazilian Atlantic coast were tested with the aim of searching the presence of lectinic and hemolytic activity. Hemagglutinating activity for human erythrocytes and for distinct animals were found in 12 of the 20 tested extracts. The extracts of Axinella corrugata, Chondrilla nucula, Chondrosia collectrix, Cinachyrella alloclada and Guitarra sp1. were the ones that presented highest hemagglutinating activity. Ten of the 12 hemagglutinating extracts had the activity inhibited by one or more sugars or glycoproteins. The lectin from Chondrilla nucula was resistant to thermal denaturation when heated up to 100 ºC for 60 minutes. Hemolytic activity was only found in the extracts from Petromica citrina and Acervochalina sp. The species of sea sponges that showed major potential for futures studies of their lectins were Axinella corrugata, Chondrilla nucula and Chondrosia collectrix, due to the highest hemagglutinating activity presented by their extracts, allied to the highest specific activity.

Studies of the persorption of large particles from radio-labelled cation exchangers.

Experiments were carried out in pigs to ascertain to what extent the cation exchangers Ujolyt and Campanyl used in the prevention of urinary stones undergo persorption and appear in the urine. We used two preparations of different grain size and detected them by labelling with 35S. A maximum of 0.5% or 5 X 10(-3) of the dose was found as persorbed particles at 51 h, chiefly in the muscles. The number of persorbed particles from the fine-grained preparation was considerably greater than that from the coarse-grained product. The urine contained the smallest proportion of particles, less than 2 X 10(-5) of the dose. In view of these results there is no reason to believe that solid particles persorbed during treatment with ion exchange resins can act as crystallization centres for stone formation, and it is equally unlikely that ion exchangers have to reach the urine before they can exert their effect.