Extensive abdominal surgery after caustic ingestion.
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OBJECTIVE: To report the authors' experience in extensive abdominal surgery after caustic ingestion, and to clarify its indications. SUMMARY BACKGROUND DATA: After caustic ingestion, extension of corrosive injuries beyond the esophagus and stomach to the duodenum, jejunum, or adjacent abdominal organs is an uncommon but severe complication. The limit to which resection of the damaged organs can be reasonably performed is not clearly defined. METHODS: From 1988 to 1997, nine patients underwent esophagogastrectomy extended to the colon (n = 2), the small bowel (n = 2), the duodenopancreas (n = 4), the tail of the pancreas (n = 1), or the spleen (n = 1). Outcome was evaluated in terms of complications, death, and function after esophageal reconstruction. RESULTS: Five patients required reintervention in the postoperative period for extension of the caustic lesions. There were two postoperative deaths. Seven patients had secondary esophageal reconstruction 4 to 8 months (median 6 months) after initial resection. Three additional patients died 8, 24, and 32 months after the initial resection. Three survivors eat normally, and one has unexplained dysphagia. CONCLUSIONS: An aggressive surgical approach allows successful initial treatment of extended caustic injuries. Early surgical treatment is essential to improve the prognosis in these patients. (+info)
European course on HPV associated pathology: guidelines for primary care physicians for the diagnosis and management of anogenital warts.
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The European Course on HPV Associated Pathology (ECHPV) was founded in 1990 by a group of clinicians, pathologists, and virologists to teach important principles for the practice and management of human papillomavirus (HPV) disease to gynaecologists, dermatologists, and other medical disciplines. These guidelines are intended to assist the practice of primary care physicians for diagnosis and treatment of anogenital warts. (+info)
Patterns and problems of deliberate self-poisoning in the developing world.
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Deliberate self-harm is a major problem in the developing world, responsible for around 600 000 deaths in 1990. The toxicity of available poisons and paucity of medical services ensure that mortality from self-poisoning is far greater in the tropics than in the industrialized world. Few data are available on the poisons most commonly used for self-harm in different parts of the world. This paper reviews the literature on poisoning, to identify the important poisons used for self-harm in these regions. Pesticides are the most important poison throughout the tropics, being both common and associated with a high mortality rate. In some regions, particular pesticides have become the most popular method of self-harm, gaining a notoriety amongst both health-care workers and public. Self-poisoning with medicines such as benzodiazepines and antidepressants is common in urban areas, but associated with few deaths. The antimalarial chloroquine appears the most significant medicine, self-poisoning being common in both Africa and the Pacific region, and often fatal. Paracetamol (acetaminophen) is used in many countries but in few has it reached the popularity typical of the UK. Domestic and industrial chemicals are responsible for significant numbers of deaths and long-term disabilities world-wide. Self-poisoning with plant parts, although uncommon globally, is locally popular in some regions. Few of these poisons have specific antidotes. This emphasizes the importance of determining whether interventions aimed at reducing poison absorption actually produce a clinical benefit, reducing death and complication rates. Future research to improve medical management and find effective ways of reducing the incidence of self-harm, together with more widespread provision of interventions proven to be effective, could rapidly reduce the number of deaths from self-poisoning in the developing world. (+info)
Purification and structure elucidation of the N-acetylbacillosamine-containing polysaccharide from Bacillus licheniformis ATCC 9945.
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The exopolysaccharide of Bacillus licheniformis ATCC 9945 (formerly B. subtilis ATCC 9945) contains among other glycoses 4-acetamido-2-amino-2,4,6-trideoxy-D-glucose, termed N-acetylbacillosamine (Bac2N4NAc). A similar diamino glycose, 2-acetamido-4-amino-2,4,6-trideoxy-D-glucose, was found in a surface layer (S-layer) glycoprotein preparation of Clostridium symbiosum HB25. Electron microscopic studies, however, showed that B. licheniformis ATCC 9945 is not covered with an S-layer lattice, indicating that the N-acetylbacillosamine present in that organism might be a constituent of a cell wall-associated polymer. For elucidation of the structure of the N-acetylbacillosamine-containing polysaccharide, it was purified from a trichloroacetic acid extract of B. licheniformis ATCC 9945 cells. Using different hydrolysis protocols and a hydrolysate of the S-layer glycoprotein preparation from C. symbiosum HB25 as reference, the purified polysaccharide was found to contain 2,4-diamino-2,4,6-trideoxy-glucose, 2-acetamido-2-deoxy-glucose, 2-acetamido-2-deoxy-galactose and galactose in a molar ratio of 1 : 1 : 1 : 2. One- and two-dimensional NMR spectroscopy, including 800 MHz proton magnetic resonance measurements, in combination with chemical modification and degradation experiments, revealed that the polysaccharide consists of identical pyruvylated pentasaccharide repeating units with the structure: [-->3)-[(S)Py-(3,4)-beta-D-Galp-(1-->6)]-alpha-D-GlcpNAc-(1-->3)-beta-D-Bacp2N4NA c-(1-->3)-[(S)Py-(3,4)-beta-D-Galp-(1-->6)]-beta-D-GalpNAc-(1-->](n) (+info)
Ingestion of caustic substances and its complications.
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CONTEXT: Caustic substances cause tissue destruction through liquefaction or coagulation reactions and the intensity of destruction depends on the type, concentration, time of contact and amount of the substance ingested. OBJECTIVES: To analyze the complications in patients who ingested caustic substances and correlate them with the amount of caustic soda ingested. DESIGN: Retrospective study. SETTING: University hospital, a referral center. PARTICIPANTS: A total of 239 patients who ingested caustic soda. MAIN MEASUREMENTS: The amount of granulated caustic substance ingested was measured as tablespoonfuls and the following complications were analyzed: esophagitis, esophageal stenosis and progression to cancer, fistulas, perforations, stomach lesions, brain abscesses, and death. Stenosis was classified as mild, moderate or severe according to the radiological findings. RESULTS: We observed an 89.3 % incidence of esophagitis; 72.6 % of the cases involved progression to stenosis and 1 per cent died during the acute phase. Stenosis was mild in 17.6 % of cases, moderate in 59.3 % and severe in 23 %. The incidence of stenosis was 80.8 per cent in women and 62.5 % in men. The incidence of stenosis was 46.9 % in the group that ingested "fragments" and 93.6 % in the group that ingested one or more tablespoonfuls of caustic substances. Among subjects who ingested one or more tablespoonfuls, 32.2 % developed lesions of the stomach-duodenum, whereas the ingestion of "fragments" was not sufficient to induce these lesions. There was no correlation between the intensity of lesions of the esophagus and of the stomach. Progression to cancer of the esophagus occurred in 1.8 % of cases, death during the chronic phase in 1.4 %, perforations in 4.6 %, fistulas in 0.9 %, and brain abscesses in 1.4 %. CONCLUSIONS: The complications were related to the amount of caustic soda ingested. Small amounts caused esophagitis or stenosis and large amounts increased the risk of fistulas, perforations and death. (+info)
In vitro gas production measurements to evaluate interactions between untreated and chemically treated rice straws, grass hay, and mulberry leaves.
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In vitro gas production was measured to investigate associative effects of untreated and chemically treated rice straw (RS) and of RS and grass hay or mulberry leaves (ML). The RS was treated with NaOH, urea, or (NH4)HCO3. Cumulative gas production was recorded at 2, 4, 6, 8, 12, 16, 24, 36, 48, 60, 72, and 96 h of incubation, and the Gompertz function was used to describe the kinetics of gas production. Treatment with NaOH, urea, and NH4HCO3 increased (P < 0.05) gas production at 48 h by 55, 52, and 37% and the maximum rate of gas production of RS from 0.64 to 1.51, 1.27, and 1.13 mL/h, respectively. The inclusion of treated straws, hay, and ML in a mixture with RS at increasing proportions (25, 50, 75, 100%) elevated cumulative gas production and its rate. Maximum gas production was not different between the RS and its mixtures with the treated straws, but inclusion of hay into RS or NH4HCO3-treated RS increased the maximum gas production. Associative effects were defined as the difference between the observed gas production for the mixtures and the sum of the individual component feeds. The NaOH-treated RS, included at higher proportions, had positive associative effects at all times of incubation < 96 h; effects were negative or absent at 96 h. No effects were observed with mixtures of RS with urea-treated RS. The NH4HCO3-treated RS mixture tended to have negative associative effects at all three levels. Positive associative effects (P < 0.05) were observed for both RS and NH4HCO3-treated RS at almost all inclusion levels of hay or ML after 12 to 96 h of incubation. The response was more pronounced with ML than with hay. Associative effects generally declined with duration of incubation. We conclude that positive associative effects on in vitro gas production occurred more consistently when RS was incubated in mixtures with hay or ML than when incubated in mixtures with chemically treated RS. (+info)
Trichloroacetic acid as a biomarker of exposure to disinfection by-products in drinking water: a human exposure trial in Adelaide, Australia.
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We addressed the need for a biomarker of ingestion exposure to drinking water disinfection by-products by performing a human exposure trial. We evaluated urinary excretion of trichloroacetic acid (TCAA) as an exposure biomarker using 10 volunteers who normally consume their domestic tap water. We recruited the volunteers at a water quality research laboratory in Adelaide, Australia. Participants maintained a detailed consumption and exposure diary over the 5-week study. We also analyzed tap water and first morning urine (FMU) samples for TCAA, and tap water for chloral hydrate (CH). We documented both interindividual and intraindividual variability in TCAA ingestion and urinary excretion, and both were substantial. With a TCAA-free bottled water intervention, we used creatinine-adjusted urinary TCAA levels to estimate urinary TCAA excretion half-lives for three of the participants. We observed correspondence over time between estimated TCAA excretion, calculated from TCAA + CH ingestion levels, and measured TCAA urinary excretion. This study demonstrates the merits and feasibility of using TCAA in FMU as an exposure biomarker, and reveals remaining concerns about possible alternate sources of TCAA exposure for individuals with low drinking water ingestion exposure. (+info)
IGF-I, IgA, and IgG responses to bovine colostrum supplementation during training.
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This study examined the effect of bovine colostrum (Dynamic colostrum) supplementation on blood and saliva variables (study 1) and the absorption of orally administered human recombinant insulin-like growth factor (IGF)-I (rhIGF-I) labeled with 123I (123I-rhIGF-I) (study 2). In study 1, adult male and female athletes were randomly assigned in a double-blind fashion to either an experimental (Dynamic; n = 19) or a control (Placebo; n = 11) group. The former consumed daily 20 g of Dynamic supplement, and the latter 20 g of maltodextrin during a 2-wk training period. After bovine colostrum supplementation, significant increases were noticed in serum IGF-I (P < 0.01) and saliva IgA (P < 0.01) in Dynamic compared with Placebo. In study 2, gel electrophoresis was carried out in 12 adult subjects with serum samples taken 60 min after ingestion of 123I-rhIGF-I and showed peaks at 0.6 and at 40-90 kDa, with the former inducing 96% and the latter 4% of the total radioactivity. It was concluded that a long-term supplementation of bovine colostrum (Dynamic) increases serum IGF-I and saliva IgA concentration in athletes during training. Absorption data show that ingested 123I-rhIGF-I is fragmented in circulation and that no radioactive IGF-I is eluted at the positions of free, or the IGF, binding proteins, giving no support to the absorption of IGF-I from bovine colostrum. (+info)