Heat treatment enhances the antimicrobial activity of (+)-Catechin when combined with copper sulphate.

UNLABELLED: The aim of the study was to compare the antimicrobial activities of freshly made, heat-treated (HT) and 14 day stored (+)-Catechin solutions with (+)-catechin flavanol isomers in the presence of copper sulphate. (+)-Catechin activity was investigated when combined with different ratios of Cu(2+) ; 100°C heat treatment; autoclaving; and 14 day storage against Staphylococcus aureus. Cu(2+) -(+)-Catechin complexation, isomer structure-activity relationships, and H2 O2 generation were also investigated. Freshly made, HT, and 14 day stored flavanols showed no activity. While combined Cu(2+) -autoclaved (+)-Catechin and -HT(+)-Catechin activities were similar, HT(+)-Catechin was more active than either freshly made (+)-catechin (generating more H2 O2 ) or (-)-Epicatechin (though it generated less H2 O2 ) or 14 day-(+)-Catechin (which had similar activity to Cu(2+) controls-although it generated more H2 O2 ). When combined with Cu(2+) , in terms of rates of activity, HT(+)-Catechin was lower than (-)-Epigallocatechin gallate and greater than freshly made (+)-Catechin. Freshly made and HT(+)-Catechin formed acidic complexes with Cu(2+) as indicated by pH and UV-vis measurements although pH changes did not account for antimicrobial activity. Freshly made and HT(+)-Catechin both formed Cu(2+) complexes. The HT(+)-Catechin complex generated more H2 O2 which could explain its higher antimicrobial activity. SIGNIFICANCE AND IMPACT OF THE STUDY: Natural products attract considerable attention in the search for novel antimicrobials, prebiotics and antioxidants. Enhanced biological activity of natural products has been demonstrated with chemical and heat treatment. This article extends the few publications on heat treatments of plant products and combinations with adjuncts, to raise antimicrobial activity against pathogens such as Staphylococcus aureus. We demonstrated that heat treatment could increase the activity of (+)-Catechin, a weak antimicrobial flavanol found commonly in plants in the presence of copper sulphate. Heat treatment of readily available resources merits consideration in the development of more potent substances for use in clinical settings and agriculture.

Cattle, weather and water: mapping Escherichia coli O157:H7 infections in humans in England and Scotland.

Entero-haemorrhagic Escherichia coli O157:H7 is a zoonotic pathogen, responsible for a relatively small number of food poisoning and illness outbreaks each year, when compared with other food-borne bacteria capable of causing infections in the population. Nevertheless, E. coli O157:H7 is a bacterial pathogen associated with severe human illnesses including bloody diarrhoea and haemolytic uremic syndrome occurring in both outbreak and sporadic settings. In England and Wales approximately 1% of all laboratory-confirmed cases of food poisoning are the result of E. coli O157:H7; however, in Scotland this figure increases to 3%. When the size of the population is taken into account and the rate of E. coli O157:H7 confirmed cases per 100,000 population is examined, the rate of E. coli 0157:H7 infections in Scotland is much greater than England and Wales. The routes of transmission have changed over time, with new routes of transmission such as farm visits emerging. The prevalence of E. coli O157:H7 has a seasonal dependency, with greater faecal shedding of the organism in the warmer months; this is directly mirrored in the increased reporting of E. coli O157:H7 infection among hospitalized patients. This review attempts to suggest why this phenomenon occurs, paying particular attention to weather, animal movement and private water supplies.

Antimicrobial pomegranate rind extracts: enhancement by Cu(II) and vitamin C combinations against clinical isolates of Pseudomonas aeruginosa.

Recently, natural products have been further evaluated as sources of antimicrobial agents with efficacies against a variety of microorganisms. This study reports the antimicrobial activities of pomegranate rind extract (PRE) in combination with Fe(II) and Cu(II) salts against extended-spectrum multidrug-resistant Pseudomonas aeruginosa. Antimicrobial suspension assays were carried out using aqueous extract of pomegranate alone or in combination with metals salts against P. aeruginosa. The extract:metal salt combination was also enhanced with the addition of vitamin C. Marked activities were observed for the aqueous PRE/Cu(II) preparations, which were greatly enhanced by the addition of the reductant vitamin C. In contrast, the aqueous PRE/Fe(II) preparations were inactive, regardless of addition of vitamin C. The combination of PRE and Cu(II) salts and vitamin C showed the greatest activity against clinical isolates of P. aeruginosa. These results warrant further investigation of PRE as a potential source of new antimicrobial agents.

Perforated colonic carcinoma presenting as epididymo-orchitis and Fournier's gangrene.

Epididymo-orchitis is a relatively common diagnosis in elderly men, often related to prostatic outflow obstruction. A 70-year-old man presented with a 4-day history of swelling and pain in the scrotum, fevers, dysuria and frequency. He had severe symptoms of prostatic hypertrophy. Physical examination and urine microscopy confirmed the diagnosis of left epididymo-orchitis and antimicrobial therapy was commenced. Subsequently, however, he developed severe necrotizing fasciitis (Fournier's gangrene) of the scrotum requiring surgical debridement, and at laparotomy, a perforated carcinoma of the sigmoid colon was found at the level of the left deep inguinal ring. Despite further radical surgery the gangrene extended, his condition deteriorated and he died. There has been no other similar case reported in the literature, and thus, although rare, intra-peritoneal causes of infection should be considered in patients with Fournier's gangrene.

Recurrent melanoma of the leg and polypoid lesions of the gallbladder--a management dilemma.

Isolated limb perfusion (ILP) is a well-tolerated method of regional chemotherapy for melanoma, with response rates ranging from 40-80%, used to treat recurrences or metastases confined to the limb from which the original tumour was excised. We present the case of a 75-year-old woman with a third recurrence of melanoma of the left leg, referred for ILP, in whom staging investigations revealed two probable malignant polypoid lesions of the gallbladder (PLG). These were thought likely to represent metastatic melanoma. In view of the diagnostic difficulty, she underwent laparoscopic cholecystectomy together with left superficial femoral ILP. Multiple papillary adenomatosis, with dysplasia ranging from mild to severe, and with areas of invasive adenocarcinoma, were found on gallbladder histology. No previous case of this combination of tumours has been reported. This case provides evidence of an adenoma-carcinoma sequence, and to our knowledge no previous case has been reported with both carcinoma and the full range of dysplasia from mild to severe within the same gallbladder. The use of minimally invasive surgery allowed the ILP to be performed at the same operation. The pathology, natural history and place of laparoscopic surgery in the management of PLG is discussed.

The interventional magnetic resonance unit--the minimal access operating theatre of the future?

Interventional magnetic resonance units give the surgeon the potential to use intraoperative imaging to guide the surgical procedure. The advantages of magnetic resonance (MR) over other intraoperative imaging modalities include excellent soft tissue resolution, lack of ionizing radiation and the ability to reconstruct images in any desired plane. Postulated advantages include the ability to confirm adequate tumour resection, reduction in procedure magnitude and complication rate, shortened inpatient stay and the development of novel minimally invasive techniques including the use of thermal energy to destroy lesions. Fully MR compatible anaesthetic and patient monitoring equipment is available. However, before the MR-guided minimally invasive surgery can become a reality, much work is required in the assessment and development of MR compatible surgical instrumentation and equipment. This review describes the testing and development of instruments and equipment for MR image-guided surgery that we have undertaken. We describe the techniques we employ for open and minimal access surgery within this unique environment. The difficulties of operating within such an environment and the safety issues that this engenders are discussed. The current applications of intraoperative MR in the main surgical specialities are reviewed, and possible future areas of development for MR-guided minimally invasive surgery described.

Upright dynamic MR defaecating proctography in an open configuration MR system.

We describe our experience evaluating an MR proctography technique using an open 0.5 T MR system. Evacuation of a gadolinium-containing rectal contrast agent was dynamically imaged in the upright position using a fast gradient echo sequence. Anatomical and functional abnormalities were documented. Results from 40 patients who underwent this technique are reported. The method is proposed as an alternative to conventional fluoroscopic proctography.

Surgical intervention in acute pancreatitis: indications, techniques and complications.

Acute pancreatitis is a disease with a significant morbidity and mortality. It has been reported as the principal diagnosis in 2% of hospital admissions with abdominal pain in the UK. The incidence is in the range of 200 to 300 cases per million population per year, but it is probably increasing. The overall mortality rate is 10 to 12%. The management of the disease and its complications requires close co-operation between surgeon, radiologist and gastroenterologist. There have been a number of improvements in the management of acute pancreatitis in the last decade.

[Laparoscopic and general surgery guided by open interventional magnetic resonance]. / Chirurgia generale e laparoscopica videoguidata dalla risonanza magnetica in configurazione open.

Interventional magnetic resonance (IMR) machines have produced unique opportunity for image-guided surgery. The open configuration design and fast pulse sequence allow virtual real time intraoperative scanning to monitor the progress of a procedure, with new images produced every 1.5 sec. This may give greater appreciation of anatomy, especially deep to the 2-dimensional laparoscopic image, and hence increase safety, reduce procedure magnitude and increase confidence in tumour resection surgery. The aim of this paper was to investigate the feasibility of performing IMR-image-guided general surgery, especially in neoplastic and laparoscopic field, reporting a single center -- St. Mary's Hospital (London, UK) -- experience. Procedures were carried out in a Signa 0.5 T General Elettric SP10 Interventional MR (General Electric Medical Systems, Milwaukee, WI, USA) with magnet-compatible instruments (titanium alloy instruments, plastic retractors and ultrasonic driven scalpel) and under general anesthesia. There were performed 10 excision biopsies of palpable benign breast tumors (on female patients), 3 excisions of skin sarcoma (dermatofibrosarcoma protuberans), 1 right hemicolectomy and 2 laparoscopic cholecystectomies. The breast lesions were localized with pre- and postcontrast (intravenous gadolinium DPTA) sagittal and axial fast multiplanar spoiled gradient recalled conventional Signa sequences; preoperative real time fast gradient recalled sequences were also obtained using the flashpoint tracking device. During right hemicolectomy intraoperative single shot fast spin echo (SSFSE) and fast spoiled gradient recalled (FSPGR) imaging of right colon were performed after installation of 150 cc of water or 1% gadolinium solution, respectively, through a Foley catheter; imaging was also obtained in an attempt to identify mesenteric lymph nodes intraoperatively. Concerning laparoscopic procedures, magnetic devices (insufflator, light source) were positioned outside scan room, the tubing and light head being passed through penetration panels. Intraoperative MR-cholangiography was performed using fast spin echo (SSFSE) techniques with minimal intensity projection 3-dimensional reconstruction. About skin sarcomas, 2 of them were skin recurrences of previously surgically treated sarcomas (all of them received preoperative biopsy) and the extent of the lesion was then determined using short tau inversion recovery (STIR) sequence. The skin was closed in each case without need for any plastic reconstruction. The breast lesions were visualized with both Signa and real-time imaging and all enhanced with contrast: 2 (20%) were visualized only after contrast enhancement; intraoperative real time imaging clearly demonstrated a resection margin in all cases. Maximum dimensions of breast specimens (range 8-50 mm, median 24.5 mm) were not significantly different from those measured by Signa (p>0.17, Student's paired t-test) or real time images (p>0.4): also there was no significant difference in lesion size between Signa and real time images (p>0.25). All postprocedure scans clearly demonstrated complete excision. The extent of the tumor at MR imaging was greater in each case than suggested by clinical examination. Adequate resection margins were planned using STIR sequences. Histological examination confirmed clear surgical margins of at least 1 cm in each case. During right hemicolectomy, both intraoperative SSFSE and FSPGR contrast imaging revealed the lesion and details of the colonic surface; imaging of the lymph node draining right colon was only partially successful, due to movement artifact. Concerning laparoscopic procedures, both FSE and SSFSE techniques produced reasonable images of the gallbladder and intrahepatic ducts, but the FSE imaging was of poor quality due to respiration artifact; however, SSFSE allowed visualization of the gallbladder and part of the common bile duct. About skin sarcomas, the extent of the tumor at MR imaging was greater in each case than suggested by clinical examination and in each case the complete tumor excision was confirmed. Histological examination confirmed clear surgical margins of at least 1 cm in each case. Intraoperative MR scanning reliably identifies palpable breast tumours and skin sarcomas and is sufficiently accurate to guide their surgical excision. Further work may be done to develop laparoscopic and open abdominal surgery as well.

Sigmoidoscopy in a nurse-practitioner community clinic using telemedicine.

We evaluated the feasibility of remote endoscopy in a community setting. Realtime teleconsultation and telesigmoidoscopy were carried out by a nurse practitioner at a community clinic while a colorectal specialist was present at the main hospital. Rigid video-sigmoidoscopes were used and the images were transmitted via ISDN lines at 384 kbit/s. Over three months, 32 patients (mean age 35 years; 19 men and 13 women) with bleeding per rectum took part in the study. Evaluation was carried out using satisfaction questionnaires for the patients, the nurse practitioner and the clinicians. The mean grade for clarity of intraluminal views was 3.5 (1 poor, 4 excellent). Only two cases had views graded less than 3, due to the presence of excessive faecal residue. All the patients were satisfied with the teleconsultation and video-endoscopy and would return for a similar visit. User satisfaction was also high on the part of the nurse practitioner and the clinician.

Hepatocolonic fistula: a rare consequence of retained gallstones after laparoscopic cholecystectomy.

Spillage of gallstones during laparoscopic cholecystectomy occurs in up to 30% of cases but complications due to stone retention are less frequent. We report the first case of a hepatocolonic fistula as a consequence of a retained gallstone.

Surgical management of polypoid lesions of the gallbladder.

BACKGROUND: With improvements in ultrasonography more polypoid lesions of the gallbladder (PLGs) are being detected. The management of these is controversial. METHODS: The demographic, radiological and pathological data of 38 patients with ultrasonographically detected PLGs were reviewed. A Medline search for such lesions was performed and a review of the literature is presented. RESULTS: Thirty-four patients underwent cholecystectomy and four were advised against or declined operation. Of the 34 who had cholecystectomy, 11 had macroscopic and histopathologically proven PLGs. Of these, seven had cholesterol polyps, two had adenomas, one had a carcinoid tumour and one had an adenocarcinoma of the gallbladder. One patient had a histopathologically normal gallbladder. The remainder had chronic cholecystitis with or without gallstones. All of the patients with neoplastic lesions of the gallbladder had solitary polyps greater than 1.0 cm in diameter. CONCLUSION: A protocol for the management of ultrasonographically detected PLGs is proposed. In this protocol it is suggested that patients with a PLG should undergo surgery if they are symptomatic, or if the PLG is 1.0 cm or more in diameter.