Intestinal alkaline phosphatase at the crossroad of intestinal health and disease - a putative role in type 1 diabetes.

BACKGROUND: Patients with type 1 diabetes have shown an increase in circulating cytokines, altered lipoprotein metabolism and signs of vascular dysfunction in response to high-fat meals. Intestinal alkaline phosphatase (IAP) regulates lipid transport and inflammatory responses in the gastrointestinal tract. We therefore hypothesized that changes in IAP activity could have profound effects on gut metabolic homeostasis in patients with type 1 diabetes. METHODS: Faecal samples of 41 nondiabetic controls and 46 patients with type 1 diabetes were analysed for IAP activity, calprotectin, immunoglobulins and short-chain fatty acids (SCFAs). The impact of oral IAP supplementation on intestinal immunoglobulin levels was evaluated in C57BL/6 mice exposed to high-fat diet for 11 weeks. RESULTS: Patients with type 1 diabetes exhibited signs of intestinal inflammation. Compared to controls, patients with diabetes had higher faecal calprotectin levels, lower faecal IAP activities accompanied by lower propionate and butyrate concentrations. Moreover, the amount of faecal IgA and the level of antibodies binding to oxidized LDL were decreased in patients with type 1 diabetes. In mice, oral IAP supplementation increased intestinal IgA levels markedly. CONCLUSION: Deprivation of protective intestinal factors may increase the risk of inflammation in the gut - a phenomenon that seems to be present already in patients with uncomplicated type 1 diabetes. Low levels of intestinal IgA and antibodies to oxidized lipid epitopes may predispose such patients to inflammation-driven complications such as cardiovascular disease and diabetic nephropathy. Importantly, oral IAP supplementation could have beneficial therapeutic effects on gut metabolic homeostasis, possibly through stimulation of intestinal IgA secretion.

The effect of fibrin sealant combined with fibrinolysis inhibitor on reducing the amount of lymphatic leakage after axillary evacuation in breast cancer. A prospective randomized clinical trial.

BACKGROUND AND AIMS: One third of women undergoing mastectomy with axillary evacuation for primary breast cancer suffer from postoperative seromas leading to unnecessary costs and complications such as infections and new operations. Different methods to prevent seroma formation have been tried without permanent success. The aim of this prospective randomised study was to examine the effect of fibrin sealant with fibrinolysis inhibitor firstly on the reduction of the amount of lymphatic leakage after axillary evacuation and secondly on the reduction of days with drains and postoperative seroma punctures. METHODS: 40 patients with primary breast cancer were prospectively randomised to the treatment group (n = 19) getting fibrin glue combined with fibrinolysis inhibitor (aprotinin) sprayed into the axillary fossa and to the control group (n = 21). RESULTS: There were no differences in the incidence of postoperative seromas between the groups. However, the seromas were easier to treat if fibrin clue was used. Total quantity (mean+/-SD) of lymphorrhea and total number of aspirations (mean+/-SD) were almost twice as high in the patients of the control group compared to those having fibrin sealant. In the treatment group seromas resolved after one or occasionally after two aspirations in 71 % of patients, while in the control group 90 % of patients needed three or more aspirations. CONCLUSION: Potentially, fibrin sealant combined with fibrinolysis inhibitor might be used for the treatment of post- axillary evacuation lymphorrhea and seroma.

Microvascular myocutaneous flaps in the lumbosacral area using the iliac artery and vein as recipient vessels.

Lumbosacral tissue defects are usually closed with local flaps. Sometimes in large high-situated defects free microvascular flaps are used. However, finding a suitable recipient vessel for microvascular anastomosis in this region is difficult. In large soft-tissue defects high in the lumbar area, closure with a free flap using the iliac artery and vein as recipient vessels channelled from the pelvic cavity to the back through a drill canal in a bone presents an alternative option where other vessels are damaged by radiotherapy or infection. This has been used successfully in two cases.

Cutaneous blood flow in the TRAM flap.

Changes in the cutaneous blood flow of the pedicled TRAM flap for breast reconstruction were studied in 15 patients with laser Doppler flowmetry (LDF) and transcutaneous oxygen tension (ptcO2). One patient was excluded from the study. The LDF value increased to 127 +/- 15% of the base line on the random and to 151 +/- 13% (p less than 0.01) on the axial side after dissection of the random side of the flap. Ligation of the deep inferior epigastric artery caused a decrease to 57 +/- 8% (p less than 0.001) on the random and to 78 +/- 11% on the axial side. The random side ptcO2 decreased from 48 +/- 2 mmHg [6.4 +/- 0.3 kPa] to 17 +/- 5 mmHg [2.3 +/- 0.7 kPa] (p less than 0.001) after dissection of the flap and remained near zero for one week. Eight patients developed minor cutaneous necrosis on the random side, probably because the superior epigastric system could not adequately nourish the TRAM flap. Low LDF and ptcO2 values after pedicle ligation and a negative response to oxygen stimulation predicted skin necrosis.