Hexaminolevulinate-induced fluorescence colonoscopy versus white light endoscopy for diagnosis of neoplastic lesions in the colon.

BACKGROUND AND STUDY AIMS: To compare the rate of detection of colorectal neoplastic lesions using the selective photosensitizer precursor hexaminolevulinate (HAL) combined with a new fluorescence video endoscope system against that of standard white light endoscopy, and secondarily, to evaluate the safety profile of HAL-induced fluorescence colonoscopy. PATIENTS AND METHODS: This prospective phase II clinical pilot study from two hospital study centers included 25 patients with known or highly suspected colorectal neoplasia. They underwent sensitization with locally applied 500 ml HAL enemas at a concentration of 1.6 mmol/L. At 60 minutes after enteral HAL administration, fluorescence imaging was done using a special light source capable of delivering either white light or blue excitation light. Red fluorescence induced by illumination with blue light was detected via a prototype fluorescence video colonoscope. Biopsies were taken from suspicious areas found with white or blue light. RESULTS: Using histology as the gold standard, 55 / 93 of neoplastic lesions were detected with white light endoscopy, 53 / 93 with both white and blue light, 38 / 93 with blue light and second-pass white light, and 27/93 with blue light only. Of all neoplastic lesions, 91 / 93 revealed red fluorescence under fluorescence imaging ( P < 0.0001). Fluorescence mode showed 38.7 % (36 / 93) more neoplasms than did white light endoscopy. An isolated slight elevation of bilirubin, by a factor of 1.5, was noted after the administration of HAL. CONCLUSIONS: Administration of HAL as enema induces selective lesion fluorescence and increases lesion detection rate in patients with colorectal neoplasia, especially of flat, nonvisible adenomas.

Early detection of premalignant conditions in the colon by fluorescence endoscopy using local sensitization with hexaminolevulinate.

BACKGROUND AND STUDY AIMS: We aimed to determine the feasibility of obtaining selective fluorescence of precancerous/cancerous lesions in the colon with a new fluorescence video endoscope system in combination with the selective photosensitizer precursor hexaminolevulinate (HAL), and to carry out a dose-finding study with evaluation of the optimal dose and application time. PATIENTS AND METHODS: 12 patients with colorectal lesions underwent sensitization with locally applied HAL enemas in two concentrations (0.8 mmol and 1.6 mmol). The examination was conducted either 30 or 60 minutes after rectal administration of the sensitizer, using a special light source capable of delivering either white or blue excitation light. Red fluorescence induced by illumination with blue light was detected via a prototype fluorescence video colonoscope. Biopsies were taken from suspicious areas found with white or blue light. Corresponding endoscopic, fluorescence, and microscopic findings were compared. RESULTS: Using histological findings as the gold standard, 52/53 of the premalignant/malignant lesions showed red fluorescence under the photodynamic diagnosis (PDD) examination; 38/53 were detected with white-light endoscopy. The PDD mode showed 28 % more polyps than did white-light endoscopic imaging. The greatest fluorescence intensity in precancerous lesions was found with retention for 60 minutes of 500 ml of 1.6 mmol HAL. CONCLUSIONS: Administration of HAL enema induces selective lesion fluorescence and increases the lesion detection rate in patients with colorectal adenoma and early carcinoma.

Control of Clostridium perfringens germination and outgrowth by buffered sodium citrate during chilling of roast beef and injected pork.

Inhibition of the germination and outgrowth of Clostridium perfringens by buffered sodium citrate (Ional) and buffered sodium citrate supplemented with sodium diacetate (Ional Plus) during the abusive chilling of roast beef and injected pork was evaluated. Beef top rounds or pork loins were injected with a brine containing NaCl, potato starch, and potassium tetrapyrophosphate to yield final in-product concentrations of 0.85, 0.25, and 0.20%, respectively. Products were ground and mixed with Ional or Ional Plus at 0, 0.5, 1.0, and 2.0%. Each product was mixed with a three-strain C. perfringens spore cocktail to obtain final spore concentrations of ca. 2.5 log10 spores per g. Chilling of roast beef from 54.4 to 7.2 degrees C resulted in C. perfringens population increases of 1.51 and 5.27 log10 CFU/g for 18- and 21-h exponential chill rates, respectively, while chilling of injected pork resulted in increases of 3.70 and 4.41 log10 CFU/g. The incorporation of Ional into the roast beef formulation resulted in C. perfringens population reductions of 0.98, 1.87, and 2.47 log10 CFU/g with 0.5, 1.0, and 2.0% Ional, respectively, over 18 h of chilling, while > or = 1.0% Ional Plus was required to achieve similar reductions (reductions of 0.91 and 2.07 log10 CFU/g were obtained with 1.0 and 2.0% Ional Plus, respectively). An Ional or Ional Plus concentration of > or = 1.0% was required to reduce C. perfringens populations in roast beef or injected pork chilled from 54.4 to 7.2 degrees C in 21 h. Cooling times for roast beef or injected pork products after heat processing can be extended to 21 h through the incorporation of > or = 1.0% Ional or Ional Plus into the formulation to reduce the potential risk of C. perfringens germination and outgrowth.

Effects of steam-flaked sorghum grain or corn and supplemental fat on feedlot performance, carcass traits, longissimus composition, and sensory properties of steers.

One hundred forty British x Exotic crossbred, yearling steers (370 kg) were used in a 2 x 2 factorial experiment to evaluate main effects and the interaction of grain type (steam-flaked sorghum grain [SFSG] or steam-flaked corn [SFC]) and level of supplemental far (0 or 4% yellow grease [YG]) on feedlot performance, diet NE concentration, carcass traits, and chemical composition and sensory properties of longissimus muscle. Steer performance and estimated dietary NEm and NEg values were not different between SFSG and SFC. Supplemental YG improved (P less than or equal to .05) gain/feed and estimated NEm and NEg of both SFSG and SFC diets. Compared with steers fed SFSG, steers fed SFC had a more yellow (P less than .05) subcutaneous fat color. Supplemental YG had an additive effect (P less than .025) on yellow color of subcutaneous fat but improved (P less than .08) the lean color of longissimus muscle. Grain type or supplemental YG had no effect on sensory properties or mechanical shear of longissimus muscle. Longissimus muscle cholesterol content was elevated (P less than .05) by supplemental YG (.49 vs .52 mg/g of wet tissue for 0 vs 4% YG, respectively); however, the biological significance of this result is questionable. Similarly, effects of YG on increased (P less than .05) stearic acid concentration and a higher concentration (P less than .05) of linoleic acid measured in longissimus muscle of steers fed SFSG vs SFC were small in magnitude. These data indicate that under the conditions of this experiment, NE contents of SFSG and SFC were similar.(ABSTRACT TRUNCATED AT 250 WORDS)

[Stress hemodynamics in hypertensive patients treated with nifedipine]. / Belastungshämodynamik bei Hypertonikern unter Nifedipin.

In 10 male juvenile hypertensives WHO stage I who are active in sports echocardiographic investigations were performed at rest and on exertion (up to 2 Watt/kg body-weight) without therapy as well as 1 hour after sublingual administration of 20 mg nifedipine and after a six-week treatment with 3 times 20 mg nifedipine a day. 51 normotensives of the same age served as reference test persons. The antihypertensive effect was distinct, but not so expressive as under the beta-blockade. From the behaviour of the heart rate (reduction under permanent therapy) of the stroke volume (increase to the highest step of exertion) and of the reduction of blood-pressure can be concluded to an economizing effect of the central haemodynamics by nifedipine on exertion. Negative inotropic effects could be excluded particularly from the behaviour of the medium circumferential speed of the velocity of the shortening of fibres on exertion. Nifedipine can be recommended for the treatment of bodily active hypertensives, when the administration of beta-blockers is not to be represented.