IHC, using antibodies against the NLS of p65, may be useful in monitoring overall NF-kappaB activity in oesophageal tissues. As IHC is amenable to high-throughput screening (whereas traditional electrophoretic mobility shift assay methods are not), this may lead to the development of a better screening tool for early cancer risk.
The pharmacokinetics of ciprofloxacin excretion have been studied in 54 patients undergoing biliary and
pancreatic operations with and without obstruction of the common bile duct. High concentrations were
achieved in common duct bile within 20 minutes of intravenous injection and persisted for over 3 hours
after 100 mg and for over 8 hours after 200 mg. The concentration of ciprofloxacin in the bile of functioning
gall bladders was much greater than that in the common duct bile. Remarkably, it was identified in
therapeutic concentrations in the bile of obstructed ducts. This and the rapid fall from initially high venous
concentrations probably reflect diffusion from the circulation as a result of the exceptional tissue
penetration. A unique feature of this study was the finding of clinically significant concentrations in the
bile of obstructed ducts.
Two patients developed wound infection and no side effects were observed. The broad spectrum
antibiotic ciprofloxacin has potential as a useful agent for prophylaxis in biliary surgery maintaining biliary
and venous concentrations in excess of the MIC90 for most biliary pathogens for more than 8 hours.
Of 363 patients with inflammatory bowel disease presenting between 1972 and 1983, 166 required definitive operation. A classification by histological type distinguishes Crohn's disease (CD) from ulcerative colitis (UC) and indeterminate inflammatory bowel disease. CD is divided into predominantly ileal disease (81), total or subtotal colonic disease (74) and distal disease (22), whilst UC is classified into colonic (95) or distal disease (63). Most patients with ileal disease required operation for chronic persistent symptoms. In patients with total colonic involvement a greater proportion of patients with CD than those with UC came to surgery. Very few patients with distal disease required surgery. After resection for ileal disease there was a low incidence of anastomotic leakage (3%) and no operative mortality. There was an overall operative mortality of 8% after colonic resection. This was much lower in the non-urgent cases but rose to 12% in urgent cases.
Case historyA 53-year-old man presented with a 3-year history of chronic pancreatitis almost certainly of alcoholic aetiology. Computerized tomography revealed a large cyst in the region of the neck of the pancreas which proved resistant to treatment by aspiration. The patient was suffering from severe chronic pain typical of pancreatitis and after full discussion, surgery was undertaken.At laparotomy the cyst was located in the pancreatic neck and the gland showed signs of chronic inflammation: no other abnormality was detected. Because a communication between the cyst and the duct system could not be demonstrated, a partial pancreatectomy was carried out and the body and tail of the pancreas were removed. The cyst was drained into a Roux loop of jejunum. The patient made an excellent recovery and at his most recent review was asymptomatic.
Cefotetan excretion was studied in 17 patients undergoing biliary or pancreatic surgery. The antibiotic was detected in bile taken from the common bile duct within 15 min of a 1 g iv bolus and therapeutic plasma levels were found up to 10 h after administration. Even higher concentrations of cefotetan were measured in the bile from functioning gall bladders, despite the presence of gall stones. Concentrations of cefotetan in bile from the common bile ducts and functioning gall bladders were greater than the plasma concentrations at all times. These concentrations exceed the in-vitro minimum inhibitory concentrations (MIC) for most common biliary tract pathogens.
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