Anti-TNF therapy is not associated with an increased risk of post-colectomy complications, a population-based study.

AIM: Previous studies have raised concerns that the use of anti-tumour necrosis factor (anti-TNF) therapy in patients with ulcerative colitis (UC) undergoing surgery may increase the risk of postoperative complications. We have taken a population-based approach to investigate whether there is an association between anti-TNF therapy and postoperative complications in UC patients undergoing subtotal colectomy. METHOD: Hospital Episode Statistics (HES) data and procedural coding were used to identify all patients in England between April 2006 and March 2015 undergoing subtotal colectomy for UC. Patients were grouped into those who received anti-TNF therapy within 12 or 4 weeks of surgery and those who did not. The incidence of postoperative complications was evaluated by HES coding and compared between groups. RESULTS: In all, 6225 UC patients underwent subtotal colectomy. 753 patients received anti-TNF therapy within 12 weeks prior to surgery (418 within 4 weeks). There was no difference in postoperative complications between groups although groups were not comparable for age and comorbidities. Logistic regression with complications as the outcome variable did not show any significant association between anti-TNF therapy and complications. Colectomy performed during an unplanned admission (vs planned admission) and smoking were associated with complications. CONCLUSION: This large population-based study does not demonstrate any association between preoperative anti-TNF therapy and postoperative complications in UC patients undergoing subtotal colectomy. The only variables associated with complications were colectomy performed during an unplanned admission and smoking.

Microbial-mediated release of bisphenol A from polycarbonate vessels.

AIM: To identify the source of bisphenol A (BPA) [2,2'-bis(4-hydroxyphenyl) propane] in cultures of an antibiotic-producing Bacillus sp. strain grown in polycarbonate flasks. METHODS AND RESULTS: Although a culture of an antibiotic-producing Bacillus sp. strain grown in a new, rinsed polycarbonate flask yielded BPA, duplicate cultures grown in thoroughly washed polycarbonate flasks did not. Cells of Escherichia coli strain C were grown in new polycarbonate flasks rinsed three-times with 100 ml distilled H2O. BPA was only recovered from cultures grown in new polycarbonate flasks, but not from the autoclaved medium incubated in parallel. CONCLUSIONS: BPA was present in either Bacillus or E. coli cultures, probably due to its release from inadequately washed polycarbonate flasks. Standard autoclaving did not result in BPA appearance; microbial growth was required. Polycarbonate vessels for microbial cultures should be thoroughly washed to avoid the appearance of BPA in culture medium. SIGNIFICANCE AND IMPACT OF THE STUDY: This study rigorously demonstrates that the presence of BPA in culture medium was a consequence of microbial growth or metabolism in inadequately washed polycarbonate flasks. As BPA exhibits antimicrobial and oestrogenic activity, searches for novel drugs or production of recombinant chemotherapeutic agents could be derailed by the artefactual appearance of BPA.

The mammalian testis accumulates lower levels of organochlorine chemicals compared with other tissues.

Tissues were obtained from three separate experiments in order to quantify the tissue distribution of organochlorine chemicals that are thought to be potential reproductive toxicants in males: 1) Sprague Dawley rats received 1 microCi of 14C-Aldrin or 14C-Dieldrin (20.6 microCi/micromole) i.p. once a week for three weeks. One week and four weeks after the last injection, tissues were harvested and stored at -80 degrees C. Tissue 14C levels were quantified by scintillation spectrometry. 2) Cis- or trans-nonachlor (0, 0.25, 2.5, 25 mg/kg body weight) were administered daily in corn oil to male rats by gavage for 28 days. Tissues were harvested and frozen at -80 degrees C on the 29th day. Organochlorine residues were extracted and quantified by gas chromatography with electron capture detection. 3) Technical grade toxaphene (0, 0.1, 0.4 or 0.8 mg/kg body weight) was ingested daily by female cynomolgus monkeys of reproductive age for 18 months prior to being mated with control males. Dosing continued during pregnancy and lactation. Their infants received toxaphene via breast milk, and upon weaning, they ingested the same dose as their mothers for 48 to 49 weeks until, at 77 to 80 weeks of age, tissues were harvested and stored at -80 degrees C. Organochlorine residues were extracted and quantified as previously stated. In all three experiments, organochlorine residues in the testis were lower than in most of the other reproductive tract and nonreproductive tract tissues we examined. For example, testicular aldrin and dieldrin levels were <5% the epididymal content; testicular cis- and trans-nonachlor were <25% the epididymal content and, testicular toxaphene levels were <15% of the epididymal content. The reasons for the low degree of accumulation by the testis in comparison with other tissues are unknown. However, the lower testicular content may afford germ cells some protection from the potentially toxic effects of these chemicals.

Dosing via gavage or diet for reproduction studies: a pilot study using two fat-soluble compounds-hexachlorobenzene and aroclor 1254.

The choice of a dosing route for in vivo toxicological tests is often dictated by practical constraints. Reproduction studies are particularly challenging in this regard since the determination of no-effect levels and allowable daily intakes from reproduction data encompasses exposure of the dam to the test xenobiotic prior to pregnancy, during gestation and during lactation. The fetus/infant can be exposed to the xenobiotic as well as the dam's metabolic products of the test xenobiotic during gestation and lactation. We initiated a series of two-litter, pilot reproduction studies with Sprague-Dawley and Fischer 344 rats to specifically ascertain the amount of xenobiotic and its metabolites ingested by the nursing neonate on lactation days 4, 7, 12, 17 and 21, when its dam received the xenobiotic via its diet or by gavage. The xenobiotics studied in this initial series of experiments were hexachlorobenzene (HCB) and Aroclor(R) 1254 (polychlorinated biphenyls; PCBs). The dams were dosed for 28 days, mated to untreated males and then remated approximately 2 weeks after weaning their first litter to a second untreated male. Dietary levels of 10 ppm HCB or 10 ppm PCBs, and gavage doses of 0.9 mg HCB or 0.8 mg PCBs/kg body weight/day were chosen and resulted in similar doses of HCB and PCBs per unit of the body weight of the dam during the premating period. There were no apparent toxicological effects regarding the dam nor were any of the reproduction parameters (feed consumption, dam weight, litter size, pup weight, external anomalies and day 4 viability index) significantly different from control values. Following impregnation, the body weight of the dam increased appreciably during gestation, but its feed consumption increased only slightly. During lactation, the dam's feed consumption increased markedly while its body weight increased slightly. Consequently, when dams received the xenobiotic in their diet they consumed slightly less xenobiotic per unit of body weight during gestation when compared to the gavaged dams, whereas the situation was dramatically reversed during lactation. While the greater consumption of xenobiotic by the dietary-dosed dams during lactation did result in more HCB (P

Toxicological consequences of Aroclor 1254 ingestion by female rhesus (Macaca mulatta) monkeys. Part 1A. Prebreeding phase: clinical health findings.

A group of 80 menstruating rhesus (Macaca mulatta) monkeys, with an average estimated age of 11.1 +/- 4.1 yr SD, were first randomly allocated to four similar test rooms (20 monkeys/room) and then randomly allocated to one of the five dose groups (four females/dose group/room). Each day, the females self-ingested capsules containing doses of 0, 5, 20, 40 or 80 micrograms Aroclor 1254/kg body weight. After 25 months of daily dosing, approximately 90% of the treated females attained a qualitative pharmacokinetic steady state with respect to the concentration of polychlorinated biphenyl in their adipose tissue. The test monkeys were monitored daily for health and menstrual status, as well as feed and water consumption. On a weekly basis, each female's body weight was determined and a detailed clinical examination was conducted. Minor treatment effects included a slight, but not statistically significant, decrease in feed and water consumption as well as a decreased feed conversion ratio and a slight increase in the duration of menses. Statistically significant, dose-related treatment effects included inflammation and/or prominence of the tarsal (Meibomian) glands, eye exudate, and various finger and toe nail changes. These results were found at doses lower than those previously reported for non-human primates.

Toxicological consequences of Aroclor 1254 ingestion by female rhesus (Macaca mulatta) monkeys. Part 1B. Prebreeding phase: clinical and analytical laboratory findings.

A group of 80 menstruating rhesus (Macaca mulatta) monkeys, with an average estimated age of 11.1 +/- 4.1 yr SD were first randomly allocated to four similar test rooms (20 monkeys/room), and then randomly allocated to one of five dose groups (four females/dose group/room). Each day, the monkeys self-ingested capsules containing doses of 0, 5, 20, 40 or 80 micrograms Aroclor 1254/kg body weight. After 25 months of daily dosing, approximately 90% of the treated females attained a qualitative pharmacokinetic steady state with respect to the concentration of polychlorinated biphenyl (PCB) in their adipose tissue. Subsequently, oestrogen and progesterone concentrations in serum were determined for one complete oestrous cycle and various immunological tests were conducted, while the monkeys continued to receive their daily dose of PCB. During the prebreeding phase of the study, blood for clinical and analytical monitoring including haematology, serum biochemistry, serum hydrocortisone, serum proteins (alpha 1, alpha 2, beta and gamma-globulins), serum immunoglobulins (A, G and M) and thyroid variables (thyroxine/triiodothyronine (T3) uptake ratio, percentage T3 uptake and free thyroxine index), were obtained monthly, as were specimens to ascertain the concentration of PCB in the blood, adipose tissue and faeces. Major findings among treated monkeys included the following: changes in haematology (decreased erythrocyte count, haematocrit, reticulocyte count, and mean platelet volume), serum biochemistry (decreased cholesterol and total bilirubin), immunotoxicity (decreased antibody production to sheep red blood cells and alterations in the percentage of T helper and T suppressor cells) and pathology (the number of regions of sebaceous gland lobules per unit of histological length was significantly reduced). These effects were observed at PCB doses lower than those previously reported for non-human primates.

Toxicological consequences of toxaphene ingestion by cynomolgus (Macaca fascicularis) monkeys. Part 1: pre-mating phase.

A total of 40 menstruating cynomolgus monkeys (Macaca fascicularis) with an average age of 7.25 +/- 1.06 years (standard deviation), five male cynomolgus monkeys with an average age of 12.6 +/- 0.66 years, and five male cynomolgus males with an average age of 6.2 +/- 0.23 years were obtained from the Health Canada breeding laboratory. The females were initially randomized to the four test groups in accordance with their previous reproductive success and body weight. They were then randomly allocated between two similar environmentally-controlled rooms (20 females/room). The males were randomly assigned to one of the test rooms (six or four males/room). The female test groups self-ingested capsules containing doses of 0, 0.1, 0.4 or 0.8 mg (Groups A, B, C, D) of technical grade toxaphene/kg body weight/day (i.e. five females/dose group/room). The older males (Group E) were proven breeders and were used exclusively for mating and their capsules contained no toxaphene. The younger males (Group F) ingested capsules containing 0.8 mg of technical grade toxaphene/kg body weight/day. After 20 weeks of daily dosing, it was assumed, based on the results of a pilot study [Andrews P., Headrick K., Pilon J.-C., Bryce F., Iverson F. (1996) Capillary GC-ECD and ECNI GCMS characterization of toxaphene residues in primate tissues during a feed study. Chemosphere 32, 1043-1053], that the treated monkeys had attained a qualitative pharmacokinetic steady state regarding the concentration of toxaphene in their adipose tissue and blood. On a daily basis, each monkey's feed and water consumption as well as its health were monitored. In addition, the females were swabbed daily to determine menstrual status. On a weekly basis, each monkey's body weight was determined and its dose of toxaphene adjusted. Detailed clinical examinations were conducted at intervals of 4 weeks or less. Periodically, starting prior to the initiation of dosing, blood samples were taken for serum biochemistry, haematology and toxaphene analysis. In addition, specimens from the nuchal fat pad were also obtained for toxaphene analysis. Statistical analysis did not reveal any effect of treatment on body weight gain, feed consumption, water consumption or haematological parameters during the 75-week pre-mating phase. The only serum biochemistry parameter which was consistently affected by treatment was cholesterol, the level of which decreased in a linear fashion as a consequence of dose, and this effect increased with time on test (P = 0.037). No other biological effects of toxaphene ingestion were found during the premating phase of this toxicological-reproduction study.

Toxicological consequences of aroclor 1254 ingestion by female rhesus (Macaca mulatta) monkeys. Part 2. Reproduction and infant findings.

A group of 80 menstruating rhesus (Macaca mulatta) monkeys were randomly allocated to four similar test rooms (20 monkeys/room) and then randomly allocated within each room to one of five dose groups (four females/dose group/room). Each day, the monkeys self-ingested capsules containing doses of 0, 5, 20, 40 or 80 micrograms Aroclor 1254/kg body weight. After 25 months of continuous dosing, approximately 90% of the treated females had attained a qualitative pharmacokinetic steady state with respect to the concentration of polychlorinated biphenyl (PCB) in their adipose tissue. Commencing on test month 37, each female was paired with an untreated male until either an impregnation occurred or the 29-month breeding phase of the study was completed. The females continued to receive their daily test dose during mating and gestation. To preclude an infant ingesting the mother's dosing capsule, dosing of the dam was discontinued when a nursing infant was approximately 7 wk old. Treatment was restarted when the infant was weaned at 22 wk of age. At parturition, and every 4 wk until weaning, milk and blood samples were obtained from the dam and a blood sample was obtained from the infant for PCB analysis. When the infant was 20 wk old, immunological testing was initiated and an adipose sample was obtained from the infant and dam for PCB analysis. Subsequently, further adipose and blood samples were obtained from the infant and blood specimens were obtained from the dam for PCB analysis. Concurrently, each infant was subjected to anthropometric measurements and detailed clinical examinations until it was approximately 122 wk old. At 122 wk some of the control and all of the treated infants were killed humanely and autopsied. A statistical analysis of the reproduction data provided evidence for a significant decreasing dose-related trend in conception rates and a significant increasing dose-related trend in foetal mortality. Several comparisons between impregnated and non-impregnated females did not implicate 'age' as a confounding factor regarding these results. The major findings with the infants involved some immunological test differences and mild clinical manifestations of PCB ingestion.

Measurement and comparison of prostate treatment dose to the femoral heads with 6-MV versus 10-MV photon energies.

The purpose of this paper is to compare the femoral head dose distribution of 6-MV x-rays vs. 10-MV x-rays when treating prostate patients using a 4-field initial box technique with a Michigan technique boost. First, tissue maximum ratio (TMR) calculations were utilized to project the expected dose contributions to the femoral heads from each energy based upon the average male pelvis. Then, plans for both the 6- and 10-MV energies were developed for 5 prostate patients using the ADAC Pinnacle3 (Milpitas, CA) treatment planning computer. Average doses and dose gradients were determined by examination of isodose curves. The dose contributions to the femoral heads were analyzed and compared with the tolerance dose (TD) 5/5 for this region. No significant dose differences existed between the 6- and 10-MV photon energies. This conclusion was supported by examination of point doses at depths of 3, 6, 12, and 15 cm for each energy.

St. Anthony's fire, then and now: a case report and historical review.

A rare case of morbid vasospasm, together with striking angiographic findings, is described secondary to the ingestion of methysergide by a 48-year-old woman. A brief review of the literature on similar cases is presented. A discussion of the history of ergot includes its original discovery, the epidemics of gangrene that it has caused through the ages and its past and present role in the management of migraine headache. Despite the advent of calcium channel blockers and beta-adrenergic antagonists, ergot preparations continue to play a major role in migraine therapy, so that the danger of St. Anthony's fire persists.

White clot syndrome: a rare complication of heparin therapy.

A case of white clot syndrome in a 61-year-old man is reported. The patient suffered simultaneous aortic and vena caval thromboses while receiving heparin therapy for pulmonary embolism. Thrombocytopenia was noted. Thrombectomies successfully relieved the thromboses. Apart from heparin, no factors predisposing to aortic thrombosis were evident, and the patient remained well in the succeeding 7 years since. A brief review of the literature on the white clot syndrome suggests that the entity remains poorly defined, regarding both the mechanism of heparin-induced thrombocytopenia and its relation to thrombosis.

Older consumers' perceptions of health care information sources: the effect on search behavior.

Substantial evidence has been developed regarding the identity of health care information sources preferred by the elderly. However, this research has not empirically investigated why a given source might be more or less important to this segment. To address this gap, this research investigates OTC-health care information sources in terms of their credibility, expertise and associated risk. Differences in perceptions of these characteristics across the derived information source types are then examined across heavy and light users of OTC medications.

The issue of substance abuse in the health care industry. A preliminary survey of managerial thinking.

Substance abuse in the workplace has been a growing concern in recent years and ways to detect employees and applicants who use drugs has been the subject of much debate. In this article, the results of a survey on the attitudes of medical practice human resource managers on drug testing of both employees and applicants are given. For this study, 273 human resource managers were sent questionnaires detailing various attitude statements and were asked for their level of agreement. Categories of questions included the administrators' general philosophy of drug testing, their attitudes toward the organizational impact of drug testing, their attitudes toward the implementation of drug testing and their attitudes toward specific issues pertinent to drug testing in medical groups.

Effect of polychlorinated biphenyls on several endocrine reproductive parameters in the female rhesus monkey.

Female rhesus monkeys (Macaca mulatta) ingested gelatin capsules containing daily doses of 0 (control), 5, 20, 40, or 80 micrograms of Aroclor 1254/kg/day (PCB) which was dissolved in corn oil plus glycerol. After approximately two years of dosing and when the monkeys were near an adipose tissue PCBs equilibrium, each dose group of 16 animals was randomly divided into two test groups. Daily blood samples from both groups were acquired for estrogen and progesterone analysis during one menstrual cycle. Test group 1 was sampled during February-March and test group 2 during August-September. Serum estrogen and progesterone concentrations in monkeys dosed with PCBs were equivalent to control values with the exception of the luteal phase progesterone levels in the 20 and 80 micrograms/kg/day dosed monkeys in test group 1. There was no difference in menstrual cycle length between control and treated monkeys for the month sampled, however, menses duration was marginally longer in the 80 micrograms/kg/day dose group. There were no apparent treatment related differences in the incidence of anovulatory cycles nor on the temporal relationship between the estrogen peak and menses onset, menses end or the progesterone peak.