Hypothesis: Closed postoperative peritoneal lavage (CPPL) with chlorhexidine gluconate reduces the number of intraperitoneal bacteria and improves the outcome of intra-abdominal infection. Design: Laboratory animal trial. Interventions: Intra-abdominal infection was produced in mice by the cecal ligation and puncture technique. After 16 to 18 hours, the animals underwent relaparotomy and placement of an intra-abdominal catheter for CPPL. In the first experiment animals were randomly divided into 4 groups: no lavage (served as a control), CPPL with chlorhexidine, CPPL with cefoxitin, and CPPL with lactated Ringer solution (LR). Lavage was continued intermittently every 8 hours for 24 hours. All animals received systemic cefoxitin every 8 hours for 7 days. Mortality was recorded every 8 hours for 10 days. In the second experiment, animals were divided into 3 groups: no lavage (served as a control), CPPL with chlorhexidine, and CPPL with LR. Lavage was continued intermittently every 8 hours for 24 hours. The animals were killed 48 hours after reoperation. Bacterial counts from peritoneal fluid and biopsy specimens, as well as peritoneal white blood cell counts, were measured before and after lavage. Results: Closed postoperative peritoneal lavage with chlorhexidine reduced mortality from 71% in a control group to 37% (P = .003). There was no survival benefit in either the CPPL with cefoxitin (91% mortality) (P = .14)

Conventional angiography is the current standard for the evaluation of carotid artery disease. The excellent resolution of this invasive study is offset by the potential for contrast-related, embolic, and puncture site complications. Three-dimensional magnetic resonance angiography may offer a noninvasive diagnostic alternative. We examined this possibility by performing both conventional angiography and three-dimensional magnetic resonance angiography in 13 patients. Cervical duplex scans were also obtained in these patients. Contiguous transverse cervical magnetic resonance images were acquired in a 1.5 tesla magnet, by use of a posterior neck coil and a gradient echo pulse sequence. These "raw" data were transferred to a real-time workstation where three-dimensional cervical arterial images were reformatted, magnified, and examined from multiple angles. Total study time from patient positioning to image generation was approximately 30 minutes. In all patients, on three-dimensional magnetic resonance angiography the common, external, and internal carotid arteries and distal vertebral arteries were easily discernable and correctly identified as patent, stenotic, or occluded. Three-dimensional magnetic resonance angiography was not accurate in detecting carotid ulcers. The degree of internal carotid artery stenosis measured from the three-dimensional magnetic resonance angiography studies correlated well with the internal carotid artery stenosis measured with conventional angiography (r = 0.866, r2 = 75.1%, p = less than or equal to 0.0001). This recent technologic advance represents significant progress toward achieving the goal of completely noninvasive vascular assessment in this patient population.

Although the vast majority of genomic DNA is tightly compacted during mitosis, the promoter regions of a number of genes remain in a less compacted state throughout this stage of the cell cycle. The decreased compaction of these promoter regions, which is referred to as gene bookmarking, is thought to be important for the ability of cells to express these genes during the following interphase. Previously, we reported a role for the DNA-binding protein heat shock factor (HSF2) in bookmarking the stress-inducible 70 000-Da heat shock protein (hsp70) gene. In this report, we have extended those studies and found that during mitosis, HSF2 is bound to the HSE promoter elements of other heat shock genes, including hsp90 and hsp27, as well as the proto-oncogene c-fos. The presence of HSF2 is important for expression of these genes because blocking HSF2 levels by RNA interference techniques leads to decreased levels of these proteins. These results suggest that HSF2 is important for constitutive as well as stressinducible expression of HSE-containing genes.

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