125Te NMR provides evidence of autoassociation of organo-ditellurides in solution.

The frequency of the resonance of 125Te of two organo-ditellurides, R-Te-Te-R (R = 4-CH3C6H4 and 2-(CH3)2NCH2C6H4), in solution undergoes a low-field shift as the concentration of the sample increases. In sharp contrast, the resonance of a sterically hindered ditelluride (R = (C6H5(CH3)2Si)3C) and telluric acid display the opposite effect. While the negative concentration coefficients can be explained by the change in magnetic susceptibility, the positive coefficients are consistent with autoassociation of the molecules through tellurium-centred supramolecular interactions. Although the corresponding equilibrium constants are small, the process is shown to be exothermic. However, the influence of autoassociation is much smaller than the effects of solvent polarity and the conformation of the ditelluride bond.

Genotype-specific IL8RA gene expression in bovine neutrophils in response to Escherichia coli lipopolysaccharide challenge.

Associations between the AC150887.4:c.-1768T>A SNP (rs41255711), which is located in the 5' upstream region of the IL8RA gene (also known as CXCR1), and the estimated breeding values for somatic cell score in the first (P = 0.019) and second (P = 0.035) lactations were previously reported in a population of Canadian Holstein bulls. In the present study, we evaluated the impact of this SNP on the expression of IL8RA by qRT-PCR. Neutrophils were isolated from whole blood samples from a group of cows with genotypes c.-1768AA (n = 4), c.-1768AT (n = 5) and c.-1768TT (n = 5) after the cows had been challenged in vitro with lipopolysaccharide (LPS). This study demonstrated that LPS-induced expression of IL8RA in cows with the c.-1768AA genotype was significantly greater when compared with the c.-1768AT and c.-1768TT genotypes (P < 0.05) before as well as after in vitro LPS challenge.

Identification of polymorphisms in bovine TLR2 and CARD15,associations between CARD15 polymorphisms and milk somatic cell score in Canadian Holsteins, and functional relevance of SNP c.3020A>T.

Toll-like receptor-2 (TLR2) and caspase recruitmentdomain 15 (CARD15) are important pattern recognition receptors that play a role in the initiation of the inflammatory and subsequent immune response. They have been previously identified as susceptibility loci for inflammatory bowel diseases in humans and are, therefore, suitable candidate genes for inflammatory disease resistance in cattle. The objective of this study was to identify single nucleotide polymorphisms (SNPs) in the bovine TLR2 and CARD15 and evaluate the association of these SNPs with health and production traits in a population of Canadian Holstein bulls. A selective DNA pool was constructed based on the estimated breeding values (EBVs) for somatic cell score (SCS). Gene segments were amplified from this pool in PCR reactions and the amplicons sequenced to reveal polymorphisms. A total of four SNPs, including one in intron 10 (c.2886-14A>G) and three in exon 12 (c.3020A>T, c.4500A>C and c.4950C>T)were identified in CARD15; nonewere identified in TLR2. Canadian Holstein bulls (n=338) were genotyped and haplotypes were reconstructed. Two SNPs, c.3020A>T and c.4500A>C, were associated with EBVs for health and production traits. The SNP, c.3020A>T for example, was associated with SCS EBVs (p = 0.0097) with an allele substitution effect of 0.07 score. When compared to the most frequent haplotype Hap12(AC), Hap22(TC) was associated with increased milk (p < 0.0001) and protein (p = 0.0007) yield EBVs, and hap21(TA) was significantly associated with increased SCS EBV (p = 0.0120). All significant comparison-wise associations retained significance at 8% experimental-wise level by permutation test. The role of SNP c.3020A>T in MDP induced IL-1beta expression was investigated by real-time quantitative reverse transcription-PCR (real-time quantitative RT-PCR). The induction of IL-1beta by MDP was highly variable between individuals, and no association was observed between IL-1beta expression and SNP c.3020A>T genotypes. In summary, the association study indicates that SNP c.3020A>T might play a role in the host response against mastitis; however, it is not the sole determinant of MDP induced IL-1beta expression in blood leukocytes. Further detailed studies are needed to understand the functional implications of SNP c.3020A>T.

Polymorphisms in the 5' upstream region of the CXCR1 chemokine receptor gene, and their association with somatic cell score in Holstein cattle in Canada.

Identification of regulatory elements in 5' regions of chemokine genes is fundamental for understanding chemokine gene expression in response to infection diseases. The CXCR1 receptor is expressed on the surface of neutrophils and interacts primarily with CXCL8 (IL-8), the most potent chemoattractant for neutrophils. The aim of this study was to characterize the 5' upstream region (2.1 kb) of the bovine CXCR1 chemokine receptor gene for polymorphism content and to identify in silico potential transcription-factor binding sites. The 5' flanking region was found by mining the NCBI GenBank (www.ncbi.nlm.nih.gov/). A DNA sequence from the whole genome shotgun sequence project with reference number AC150887.4 contained the CXCR1 5' flanking sequence. Computer analysis revealed potential binding sites for the transcription factors nuclear factor kappaB (NF-kappaB), binding factor GATA-1, barbiturate inducible element (Barbie), nuclear factor of activated T-cells, and activator protein 1. Polymorphism discovery in this region was conducted by constructing an inclusive DNA pool including 2 phenotypic extreme groups, 20 bulls with high estimated breeding values (EBV) for somatic cell score (SCS), and 20 bulls with low EBV for SCS. Independent amplicons along the 5' flanking region of bovine CXCR1 were generated for polymorphism discovery by sequencing. Three novel single nucleotide polymorphisms (SNP), CXCR1c.-344T>C, CXCR1c.-1768T>A, and CXCR1c.-1830A>G, and a previously identified SNP in the coding region, CXCR1c.777G>C, were identified. The 4 SNP were genotyped in Canadian Holstein bulls (n = 338) using tetra-primer amplification refractory mutation system (ARMS)-PCR. Average allele substitution effects were estimated to investigate associations between the 4 SNP and EBV for SCS in first, second, and third and later lactations. Multiple trait analysis revealed that the SNP CXCR1c.-1768T>A was associated with EBV for SCS in the first and second lactations and over all 3 lactations. Haplotype analysis substantiated this association with EBV for SCS in the first lactation. Given the location of SNP CXCR1c.-1768T>A and the surrounding potential binding recognition sequences for NF-kappaB, GATA-1, and Barbie transcription-factors, this SNP may be implicated in gene regulation and warrants further research.

Technique and survival after laparoscopically assisted right hemicolectomy.

BACKGROUND: The role of laparoscopic colon resection in the management of colon cancer is still controversial. In this article, the surgical strategy and techniques are described, with further consideration of the oncologically relevant aspects. METHODS: Between March 1993 and July 2003, we performed laparoscopic right hemicolectomy in 56 patients with right colon carcinoma. Average age was 74.5 years (range, 17-92). We performed a standardized surgical procedure that included mobilization from the vascularized mesenteric bridges with a window technique, transection of the ileocolic lymphovascular pedicle, and lateral and proximal mobilization of the ileocecum, ascending colon, right flexure, and proximale transversum. After enlargement of one of the trocar incisions the exteriorized colon was resected and an extracorporeal anastomosis was performed in the standard manner. RESULTS: There were no conversions to open. The mean operating time was 119 +/- 38 min, the mean length of resected colon was 27.8 +/- 4.48 cm, and the average width of the clear margins was 6.8 +/- 5.3 cm. One patient died. Lymph nodes were positive in 21 patients. The 5-year survival rate in the 48 patients who were operated on with curative intent was 75%. We have had two local recurrences. The overall 5-year mortality-free fraction was 63%. Cox multivariate analysis showed that the mortality-prognostic factors were tumor stage and length of resected colon, whereas Kaplan-Meier analysis showed that the mortality-prognostic factors were positive lymph nodes and tumor stage. CONCLUSIONS: Our results show that laparoscopic right hemicolectomy for colon cancer can be performed safely. Complications and recurrence rates are comparable to those for left-sided laparoscopic and open procedures. Therefore, we recommend this procedure as the method of choice. Laparoscopically treated patients with stage II and stage III disease have almost the same cumulative rate of survival.

Atropine depresses release of neurotensin and its effect on the exocrine pancreas.

In this study the effect of 10 and 20 micrograms . kg-1 . h-1 atropine sulfate on release and pancreatic effects of neurotensin was studied in 4 dogs. Neurotensin plasma levels rose significantly when a liquid fat preparation was infused intraduodenally. This rise was almost completely abolished by simultaneous infusion of atropine. Atropine further suppressed basal and fat-stimulated output of pancreatic volume, protein, and bicarbonate; it also reduced pancreatic secretion stimulated by an intravenous infusion of low doses (2.5 to 20 pmol . kg-1 . min-1) neurotensin. The effect of higher doses (80 and 240 pmol . kg-1 . min-1 of neurotensin was less affected. As neurotensin plasma levels in contrast to normal oral feeding did not rise after sham feeding, our findings suggest that release and action of neurotensin may at least in part be dependent on a cholinergic, non-cephalic mechanism.

Action of neurotensin on size, composition, and growth of pancreas and stomach in the rat.

Since the gastrointestinal peptide neurotensin has a stimulatory effect on the secretion of the exocrine pancreas and an inhibitory effect on secretion and motility of the stomach, we investigated whether chronic parenteral administration of neurotensin would affect pancreatic and gastric growth. We therefore infused synthetic neurotensin subcutaneously (dose, 43 and 282 pmol X kg-1 X min-1) in 20 Wistar rats for 2 weeks using Alzet osmotic minipumps and compared pancreatic weight, DNA, RNA, protein, lipase, amylase, pancreatic polypeptide and insulin with these parameters in 10 control rats from the same litter with subcutaneously implanted plastic cylinders approximately the size of the minipumps. In another experiment, synthetic neurotensin (836 pmol X kg-1) was injected intraperitoneally three times a day for 3 days in 12 rats. Thereafter, we measured pancreatic DNA and in vitro incorporation of [3H]thymidine into pancreatic DNA. These effects were compared with the actions of caerulein and normal saline. Long term infusion of the high neurotensin dose induced an increase of pancreatic weight (control: 0.87 g, neurotensin: 1.02 g) and of DNA (control: 2.5 micrograms; neurotensin: 3.5 micrograms) and pancreatic polypeptide (control: 2.4 ng; neurotensin: 7.4 ng) contents, whereas pancreatic protein, RNA, amylase and lipase contents were not stimulated. In relation to DNA, these parameters even were significantly depressed. Insulin remained unchanged. Intraperitoneal injection of neurotensin induced an increase of pancreatic DNA content and stimulated [3H]thymidine incorporation into DNA (control: 11 000 dpm/g; neurotensin: 15 800 dpm/g pancreas). Moreover, long-term neurotensin infusion with the high dose led to a rise in protein concentration and an increase in the thickness of the gastric antrum; antral DNA concentration was insignificantly stimulated. Parenteral neurotensin in the doses and at the times administered, led therefore, to hyperplasia of the pancreas and induced growth of the gastric antrum. It is concluded that neurotensin can act as a trophic factor on pancreas and gastric antrum of the rat. It remains to be determined whether this represents a physiological effect of neurotensin.

A new round in the discussion on the action of secretin on pancreatic protein secretion: a further study on the effect of secretin on pancreatic secretion in dogs.

Whether or not secretin stimulates pancreatic protein secretion is a controversial question. In this investigation, dose-response studies with different secretin preparations were performed in dogs with two different types of pancreatic fistulae. Pure natural secretin (Karolinska Institute, Stockholm), synthetic secretin (Hoechst, Frankfurt), synthetic secretin (Hoechst, Frankfurt), synthetic D-Ala17-secretin (Roche, Basel), and natural secretin (Kabi, Munich) were tested in dogs equipped with a Thomas cannula for collection of pure pancreatic juice. The synthetic secretin was also tested in dogs with a modified Herrera fistula. Potency of the pure natural and the unmodified synthetic secretins was similar. Whereas protein output was significantly stimulated by these secretin preparations, protein concentrations fell to approximately 10 mg ml-1 with incremental doses of infused secretin. The high protein concentrations of 60 up to 120 mg ml-1 found in pure basal pancreatic secretion, suggest that pancreatic protein output may have been a "washout" phenomenon, and that the increasing protein output values were due to rising volume flow of pancreatic juice which is not completely protein-free. Impure secretin preparations and indirect collection techniques also lead to an elevation of pancreatic protein output.

Reproduction of postprandial neurotensin plasma levels by intravenous neurotensin and the effect of neurotensin on exocrine pancreatic secretion in humans.

A fatty meal releases neurotensin immunoreactivity from the small bowel in humans and dogs, and an infusion of synthetic neurotensin elicits exocrine pancreatic secretion in these species. It is not clear, however, which amount of exogenous neurotensin will reproduce endogenous neurotensin plasma levels as postprandial neurotensin immunoreactivity is composed of several fragments of neurotensin without biologic activity in addition to intact neurotensin. In order to clarify this question, we infused 1.25, 2.5, 5.0 and 7.5 pmol/kg/min synthetic Gln4-neurotensin in four volunteers, determined neurotensin plasma levels with a radioimmunoassay recognizing only intact neurotensin, and collected duodenal contents for estimation of pancreatic secretion. On another day, we determined neurotensin plasma levels after a fatty meal. Reverse-phase high-pressure liquid chromatography (HPLC) was performed on postprandial plasma samples. We found a stimulatory action of neurotensin on pancreatic secretion of volume enzymes and bicarbonate beginning with 1.25 pmol/kg/min neurotensin. The neurotensin plasma level after infusion of this dose of synthetic neurotensin was 69 pg/ml; after the meal, maximal neurotensin plasma concentration was 50 pg/ml (basal neurotensin plasma levels in both investigations were subtracted). HPLC indicated the presence of the tridecapeptide known to be the active molecular form of neurotensin in postprandial plasma. These results suggested that neurotensin plays a role as an endocrine hormone in the postprandial regulation of exocrine pancreatic secretion in humans.

The neuropeptide head activator stimulates amylase release from rat pancreas in vitro.

The neuropeptide head activator previously located in neural cells of the freshwater hydra was found to stimulate release of amylase from rat pancreatic lobules in vitro. It is unknown whether this effect may have physiological implications.

Liposarcoma of the esophagus.

Presented here is a report on an unusual liposarcoma of the esophagus. A 66-year-old-woman was treated successfully by surgical excision without removal of the esophagus. Thirty months after surgery and radiation she presented with neither complaint nor recurrence.

Role of octreotide in the prevention of postoperative complications following pancreatic resection.

Though morbidity and mortality rates following pancreatic resection have improved in recent years, they are still around 35% and 5%, respectively. Typical complications, such as pancreatic fistula, abscess, and subsequent sepsis, are chiefly associated with exocrine pancreatic secretion. In order to clarify whether the perioperative inhibition of exocrine pancreatic secretion prevents complications, we assessed the efficacy of octreotide, a long-acting somatostatin analogue. We conducted a randomized, double-blind, placebo-controlled, multicenter trial in 246 patients undergoing major elective pancreatic surgery. Patients were stratified into a high-risk stratum (limited to patients with pancreatic and periampullary tumors) or low-risk stratum (patients with chronic pancreatitis). Patients received octreotide (3 x 100 micrograms) or placebo subcutaneously for 7 days perioperatively. Eleven complications were defined: death, leakage of anastomosis, pancreatic fistula, abscess, fluid collection, shock, sepsis, bleeding, pulmonary insufficiency, renal insufficiency, and postoperative pancreatitis. Two hundred patients underwent pancreatic head resection, 31 patients underwent left resection, and 15 patients had other procedures. The overall mortality rate within 90 days was 4.5%, with 3.2% in the octreotide group and 5.8% in the placebo group. The complication rate was 32% in the patients receiving octreotide (40 of 125 patients) and 55% in patients receiving placebo (67 of 121 patients) (p less than 0.005). In the patients in the high-risk stratum, complications were observed in 26 of the 68 (38%) patients treated with octreotide and in 46 of 71 (65%) patients given placebo (p less than 0.01). Whereas in patients in the low-risk stratum, the complication rate was 25% (14 of 57 patients) in those treated with octreotide and 42% (21 of 50 patients) in patients given placebo (p = NS). The perioperative application of octreotide reduces the occurrence of typical postoperative complications after pancreatic resection, particularly in patients with tumors.

Laparoscopic inguinal hernia repair.

BACKGROUND: We performed a prospective study to evaluate the safety and efficacy of laparoscopic hernia repair in our hospital. METHODS: A total of 2500 consecutive laparoscopic transabdominal hernia repairs (TAPP) were performed in 1952 patients. Their average age was 59 years. We used a mesh. 12 x 15cm. RESULTS: The average operating time was 32 mins. We had a recurrence rate of 1.04%. There were 89 complications (3.56%). Three were bladder injuries, one of which necessitated conversion to an open laparotomy. Three of 38 hematomas required open exploration. Three patients were reoperated because of nerve irritation. An incarcerated trocar hernia occurred in six cases. There was one wound infection at the umbilical incision. There were no infections or incompatibility reactions at the mesh. The complication rate declined over time. At the same time, the rate of recurrence decreased as we acquired more experience in laparoscopic hernia repair. CONCLUSION: Laparoscopic hernia repair can be performed safely, with low rates of recurrences and few complications are low. This technique achieves good results combined with the benefits of minimal invasive procedures.

Technique of implantation and removal of balloon catheters for the intra-aortic balloon counter pulsation.

During recent years, intra-aortic balloon counterpulsation has become the treatment of choice in patients suffering from left ventricular power failure following cardiac operations. In our clinic IABP became necessary in 55 patients out of 1873 patients operated with heart lung machine during the period under study. The patients were studied in two groups. In Group I the intra aortic balloon counter pulsation was started only after there was no response to pharmacological agents, which often included high doses of catecholamines and vasoconstrictors. The mortality in this group was 74%. The second group consisted of patients treated since 1975. In this group, the counter pulsation was started early before ventricular damage was irreversible. In this group the survival was 52%. In addition we have paid careful attention to the technique of implantation of the balloon catheter, thrombosis prophylaxis during the counter pulsation and removal of any possible thrombi in proximal and distal segments to the arteriotomy with the help of Fogarty catheters together with the closure of the arteriotomy with a vein patch. The technique described has resulted in almost no peripheral vascular complications.

[Robot arm in laparoscopic surgery]. / Roboterarm in der laparoskopischen Chirurgie.

Currently laparoscopic surgery is limited by several factors. One of them is the precise handling of optics. Up to now, in our hospital 52 laparoscopic operations have been done with a voice-controlled robot arm to handle the optics in gallbladder, stomach, large bowel and hernia operations. The visual field is determined by the surgeon. In all cases handling of the robot arm was precise and the voice response exact and without technical problems. Twenty-nine operations were done by one operator as "solo surgeries". In 20 further cases there was one assistant. A robot arm can be used successfully without problems by any laparoscopic surgeon in any operating theater.

[Laparoscopic segmental pancreas resection and pancreatic cystadenoma]. / Laparoskopische Pankreassegmentresektion bei Pankreaszystadenom.

Aside from location, the complex anatomic relationships and advanced laparoscopic skills needed in selected cases of laparoscopic pancreas surgery have increased. We report a 55-year-old woman with cystic adenoma in the area of the corpus who was treated with complete laparoscopic corpus resection while preserving the head and tail of the pancreas and the spleen. The patient was placed in lithotomy position. Four trocars were placed. After opening the bursa, the pancreas showed a 6x6x6-cm, well-bordered, cystic tumor in the corpus. Tail and head of the pancreas were free of tumor and seemed inconspicuous. After exploration of the v. porte and v. lienalis, the healthy tissue in the head area of the pancreas was divided with the linear stapler. Preparation continued in the direction of the pancreatic tail while preserving the v. lienalis. After reaching the healthy pancreas in the tail region, the tumorous segment was resected. The resected pancreas segment was placed in an endobag until removal over a slightly widened trocar incision above the symphysis. The tail segment was anastomized in situ end-to- side with the first jejunum loop behind the Treitz's ligament. There was no postoperative complication, and the postoperative course was observed. The patient returned to normal activity within 10 days after operation. Retaining high surgical standards and preserving the healthy pancreas tissue and laparoscopic anastomosis, laparoscopic surgery in cases of benign tumors of the distal pancreas is possible with all the patient benefits of minimally invasive surgery.

[Subtotal adrenalectomy versus autotransplantation of the adrenal cortex--an alternative procedure in bilateral adrenalectomy in MEN II?]. / Subtotale Adrenalektomie versus Autotransplantation der Nebennierenrinde--Alternativverfahren bei der bilateralen Adrenalektomie bei MEN II?

Complete loss of steroid production is a very remarkable effect of total adrenalectomy. This is the reason why attempt was made to preserve some adrenal cortex function in cases with bilateral adrenalectomy. Till now successful autografting of adrenal cortex has been reported only in cases with Cushing's syndrome. We now report on two cases with MEN II syndrome, in whom autografting into the rectus muscle was done successfully. In order to compare results, data on two patients with subtotal adrenalectomy are given. Outcome was similar. In all 4 cases function of adrenal cortex was demonstrated by scintigraphy and by blood chemistry. In one case with autotransplantation and in another with subtotal resection, the remaining adrenal tissue showed response to ACTH. Provided more experience, in our opinion subtotal adrenalectomy and adrenal autotransplantation in cases of MEN II syndrome might turn out to prove as equivalent procedures.

[Laparoscopic pancreatocystojejunostomy without entero-entero-anastomosis]. / Laparoskopische Pankreatocystojejunostomie ohne Entero-Entero-Anastomose.

The gradual enlargement of a persistent pancreatic pseudocyst generally requires intervention. When the decision to carry out an operative procedure is made, preference should be given to internal rather than external drainage. We have developed a simple technique in which the pseudocyst is approached directly, to make a pancreatico-cystojejunostomy, which does not require a Braun- or Roux-en-Y anastomosis. We present our laparoscopic method, which opens up new possibilities in the treatment of pancreatic pseudocysts.

[Effect of somatostatin on basal and stimulated exocrine pancreatic secretion after partial duodenopancreatectomy. A clinical experimental study]. / Auswirkung von Somatostatin auf die basale und stimulierte exokrine Pankreassekretion nach partieller Duodenopankreatektomie. Eine klinische experimentelle Studie.

In a prospective trial 30 patients underwent pancreaticoduodenectomy (Whipple operation) for cancer. They were randomly assigned to receive Somatostatin (SST) (n = 15) or not (n = 15). SST was started at laparotomy with 250 micrograms/h and given over a period of 5 days. A small catheter, which was placed into the duct of the pancreatic remnant, gave access to the pancreatic juice. Volume, amylase, lipase and protein as well as bicarbonate outputs were analyzed. As regards endocrine function, insulin and glucagon plasma levels were measured. The nitrogen balance was calculated. A stimulation test was done on the fifth postoperative day. Six patients (3/3) were assessed as drop-outs. A significant reduction was found for volume, amylase, lipase, protein and bicarbonate with SST, this effect lasting for two days. Lipase however was reduced significantly for 5 days. Pancreatic exocrine function was reduced as well after stimulation, if SST was given. Insulin and glucagon were inhibited with SST, the latter more effectively. We found a positive nitrogen-balance as early as on the second postoperative day in the SST-group, whereas without SST this did not occur before the fourth postoperative day. This findings were significant on the third and fourth postoperative day. The inhibitoric effects of SST, which are demonstrated by our laboratory investigations, conform very well with a more favorable clinical course and a reduction of perioperative morbidity and mortality.

[Prevention of thromboembolism in surgery--results of a survey in West German hospitals]. / Thromboembolie-Prophylaxe in der Chirurgie--Ergebnis einer Umfrage an westdeutschen Krankenhäusern.

UNLABELLED: In 1990 a questionnaire on methods for prevention of deep venous thrombosis (DVT) and pulmonary embolism (LE) was mailed to 940 surgical centers in West Germany (FRG). The return rate was 60% or 564 answers, covering about 1,200,000 operations/year. The results are as follows: (1) Physical therapeutic measures (early mobilisation, elastic stockings) and drug administration are routinely used in all centers. The duration of prophylaxis is 3-8 days in 36% of centers, up to mobilisation in 31%, 9-16 days after operation in 17% and until demission in 16%. (2) A single drug regime is employed in 60% of centers (49% standard heparin, 9% low molecular heparin in combination with DHE) 40% of centers use all three drugs without clear cut guidelines concerning the indications. (3) The reported rates of thromboembolic complications diagnosed by clinical criteria are 0.55 +/- 0.62% for DVT and 0.22 +/- 0.29% for fatal or nonfatal LE. There is no evidence from the analysed data that the drug regimes influences the clinical outcome. CONCLUSION: The need for administration of drugs prevent DVT is widely accepted. A polypragmatic approach seems to be effective. However, standardized regimes for defined clinical conditions are desirable.