Clinical outcomes and risk factors of post-polypectomy coagulation syndrome: a multicenter, retrospective, case-control study.

BACKGROUND AND STUDY AIMS: Post-polypectomy coagulation syndrome (PPCS) is a well known complication of colonoscopic polypectomy. However, no previous studies have reported on the clinical outcomes or risk factors of PPCS. The aim of the current study was to analyze the clinical outcomes and risk factors of PPCS developing after a colonoscopic polypectomy. PATIENTS AND METHODS: Data for all patients who underwent colonoscopic polypectomies and required hospitalization in nine university hospitals were analyzed retrospectively. The incidence, clinicopathological characteristics, and clinical outcomes of PPCS cases were examined. Additionally, patients who developed PPCS were compared with controls who were matched by age and sex, in order to assess for possible risk factors. RESULTS: The rate of PPCS that required hospitalization after colonoscopic polypectomy was 0.7/1000. All patients with PPCS were treated medically without the need for surgical interventions. The median durations of therapeutic fasting, hospitalization, and antibiotic use were 3 days, 5.5 days, and 7 days, respectively. The rates of major PPCS and mortality were 2.9 % and 0 %, respectively. On multivariate analysis, hypertension (OR = 3.023, 95 %CI 1.034 - 8.832), large lesion size (OR = 2.855, 95 %CI 1.027 - 7.937), and non-polypoid configuration (OR = 3.332, 95 %CI 1.029 - 10.791) were found to be independent risk factors related to the development of PPCS. CONCLUSIONS: In this study, the rates of major PPCS and mortality were only 2.9 % and 0 %, respectively. Hypertension, large lesion size, and non-polypoid configuration of the lesion were independently associated with PPCS. Therefore, patients may be reassured by the excellent prognosis of PPCS, while endoscopists should be especially careful when performing colonoscopic polypectomies in patients with hypertension or large and non-polypoid lesions.

Trace determination of beta-lactam antibiotics in surface water and urban wastewater using liquid chromatography combined with electrospray tandem mass spectrometry.

A sensitive and reliable method using liquid chromatography-electrospray tandem mass spectrometry has been developed and validated for the trace determination of beta-lactam antibiotics in natural and wastewater matrices. Water samples were enriched by solid-phase extraction. The analytes included amoxicillin (AMOX), ampicillin (AMP), oxacillin (OXA), cloxacillin (CLOX) and cephapirin (CEP). Average recoveries of beta-lactams (BLs) in fortified samples were generally above 75% (except amoxicillin) with the standard deviations lower than 10% in water matrices. Amoxicillin was not quantified due to poor recovery (less than 40%) in the investigated water matrices. Matrix effects were found to be minimal when measuring these compounds in water matrices. The accuracy, within- and between-run precision of the assay fell within acceptable ranges of 15% absolute. The method detection limit (MDL) was estimated to range between 8 and 10 ng/L in surface water, 13 and 18 ng/L in the influent and 8 and 15 ng/L in the effluent from a wastewater treatment plant. A large number of actual water samples were analyzed using this method in order to evaluate the occurrence of the beta-lactams in a river and a wastewater treatment plant in northern Colorado. Most of the samples were negative for all analytes. These compounds were found at 15-17 ng/L in the three influent samples and at 9-11 ng/L in three surface water samples out of a total of 200 samples. This indicates that contamination by beta-lactam antibiotics is of minor importance to the small mixed-watershed.

Clinicopathological review of 61 patients with early bile duct cancer.

AIMS: The concept of early cancer is already established in the hollow viscus. However, there is no broadly accepted concept of early bile duct cancer. We aimed to assess whether early bile duct cancer patients have characteristic clinicopathological features and a better prognosis compared with patients with advanced bile duct cancer. MATERIALS AND METHODS: Between June 1996 and December 2004, 614 patients were histologically confirmed with primary bile duct cancers after resection. Extrahepatic early bile duct cancers are defined as carcinoma where invasion is confined within the fibromuscular layer of the extrahepatic bile duct. Intrahepatic early bile duct cancers arising from intrahepatic large bile ducts are also defined as carcinoma confined within the fibromuscular layer. We retrospectively reviewed medical records to obtain demographic, laboratory, radiological and pathological data. RESULTS: Sixty-one (10%) patients were categorised with early bile duct cancers. They were frequently detected at asymptomatic (39%) or non-icteric (84%) stages. The most common gross type was the intraductal-growing type (58%). Not otherwise specified adenocarcinoma was only 67%, whereas papillary carcinoma was 31% of cancers. No lymph node metastasis and no lymphovascular/perineural invasions were noted in 89% of patients. The 5-year survival rate for early bile duct cancer was excellent (80%). CONCLUSIONS: Although early bile duct cancer is not a common disease, it is not a very rare entity either. The clinicopathological features of early bile duct cancer patients differ from those of advanced bile duct cancer patients, with asymptomatic clinical presentation, different macroscopic and microscopic findings, and excellent prognosis.

Rapid analysis of trace levels of antibiotic polyether ionophores in surface water by solid-phase extraction and liquid chromatography with ion trap tandem mass spectrometric detection.

The occurrence of antibiotics in surface and ground water is an emerging area of interest due to the potential impacts of these compounds on the environment. This paper details a rapid, sensitive and reliable analytical method for the determination of monensin A and B, salinomycin and narasin A in surface water using solid-phase extraction (SPE) and liquid chromatography-ion trap tandem mass spectrometry (LC-MS-MS) with selected reaction monitoring (SRM). Several product ions as sodiated sodium salts for MS-MS detection have been identified and documented with their proposed fragmentation pathways. Statistical analysis for determination of the method detection limit (MDL), accuracy and precision of the method is described. The average recovery of ionophore antibiotics in pristine and wastewater-influenced water was 96.0+/-8.3% and 93.8+/-9.1%, respectively. No matrix effect was seen with the surface water. MDL was between 0.03 and 0.05 microg/L for these antibiotic compounds in the surface water. The accuracy and day-to-day variation of method fell within acceptable ranges. The method is applied to evaluate to the occurrence of these compounds in a small watershed in Northern Colorado. The method verified the presence of trace levels of these antibiotics in urban and agricultural land use dominated sections of the river.

Synthesis of phosphatidylserine in carrot cells cultured under carbon-source starvation.

When carrot suspension cells were cultured on medium containing no carbon source (starvation), the levels of phosphatidylserine (PS) increased transiently 3-4 d after the initiation of starvation while levels of most other phospholipid (PL) species decreased. We previously reported that fatty acids of these PLs served as an alternative carbon source during starvation. The present study showed that cells possess two different biosynthetic pathways involving phosphatidylcholine (PC)/phosphatidylethanolamine (PE) exchange enzymes and PS synthase to synthesize PS. These activities peaked similarly 4 d after the initiation of starvation and coincided with the peak of PS level. The synthesis of serine was also significantly activated during starvation. The activity of phosphoserine aminotransferase (PSAT) which is involved in serine synthesis increased with a time course similar to that of the increase in the PS level. These observations suggest that the increase in PS level plays an important role in membranes which are degraded during starvation.

Multi-organ failure caused by reactivated coccidioidomycosis without dissemination in a patient with renal transplantation.

OBJECTIVE: The acute respiratory failure caused by pulmonary coccidioidomycosis without dissemination is an extremely unusual event. CASE REPORT: We report a 47-year-old renal transplanted man with a reactivated pulmonary coccidioidomycosis, whose clinical course presented as fulminant respiratory failure, disseminated intravascular coagulation and profound hypotension mimicking bacterial pneumonia and septic shock. Lung biopsy showed conglomerated necrotizing granulomas containing many spherules filled with endospores of Coccidioides immitis. CONCLUSION: Coccidioidomycosis should be included in the differential diagnosis of acute sepsis, particularly in an immunocompromised host who has travelled in an endemic area.