Colon stenosis caused by old portal vein thrombosis.

A 58-year-old female with a history of portal vein thrombosis was referred to our hospital with abdominal pain and distention. Colon fiber and enema of the colon showed stenosis at the transverse colon and the ascending colon, with edematous mucosa. Laparotomy revealed no abnormal findings other than chronic ischemia of the colon. To our knowledge, this is the first reported case of colon stenosis caused by portal vein thrombosis.

Large cholesterol polyp of the gallbladder mimicking gallbladder carcinoma.

Gallbladder tumors larger than 10 mm in diameter have a high incidence of malignancy. We report an extremely rare case of a large cholesterol polyp of the gallbladder mimicking gallbladder carcinoma. Ultrasonography and computed tomography showed a larger papillary mass in the fundus of the gallbladder with a maximum diameter of about 30 mm, the largest gallbladder polyp ever reported to our knowledge.

Endovascular surgery as the first-choice treatment for ruptured cerebral aneurysms: how far has it come?

SUMMARY: One hundred and seventy patients with ruptured cerebral aneurysms were treated by coil embolization from September 1997 to December 2002. After January 2000, coil embolization was selected as the first-choice treatment for ruptured aneurysms. During this period, the authors investigated the number of aborted cases, the number of complications, and how many patients could be treated by coil embolization according to the locations of ruptured cerebral aneurysms. One hundred and ninety-five sessions were performed on 170 patients, and 13 sessions (6.7%) were aborted mainly because of the difficulty of the approach and the wide necks of the aneurysms. In four patients, although procedural perforation and haemorrhage occurred, the outcome was good or excellent. Eight poorgrade patients experienced haemorrhage after coil embolization and seven patients died. The volume embolization ratios of small and large aneurysms were 27% and 21%, and the recanalization of small and large aneurysms occurred in 9% and 38% of patients, respectively. From January 2000 to December 2002, 119 (66%) of 180 ruptured cerebral aneurysms were treated by coil embolization. According to the location of aneurysms, 89% vertebrobasilar, 87% anterior cerebral, 65% internal carotid and 24% middle cerebral artery aneurysms could be treated by coil embolization. Because the tight packing of large aneurysms was difficult, the recanalization rate of large aneurysms was high. However, the results of small aneurysms were satisfactory. Almost 90% of vertebrobasilar and anterior cerebral artery aneurysms could be treated by coil embolization.

Phytochemical flavones isolated from Scutellaria barbata and antibacterial activity against methicillin-resistant Staphylococcus aureus.

A crude extract prepared from Scutellaria barbata D. Don (Lamiaceae) was analyzed in the effort to discover antibacterial compounds against high-level strains of methicillin-resistant Staphylococcus aureus (MRSA). Apigenin and luteolin were isolated from the plant as active constituents against the bacteria. These flavonoid congeners were selectively toxic to S. aureus, including the MRSA and methicillin-sensitive S. aureus strains.

The ratio of interleukin-6 to interleukin-10 correlates with severity in patients with chest and abdominal trauma.

To evaluate the relation between proinflammatory cytokines and antiinflammatory cytokines after major trauma, we measured pro-inflammatory cytokine (interleukin [IL]-6) and antiinflammatory cytokine (IL-10) concentrations after trauma, and evaluated the relationship between the ratio of IL-6 to IL-10 and injury severity. In 20 patients who sustained chest and abdominal trauma, IL-10, IL-6, and lactate concentrations were measured at 0, 1, 2, and 4 days. The Injury Severity Score (ISS), Acute Physiology and Chronic Health Evaluation (APACHE) II score, and the ratio of IL-6 to IL-10 were calculated. IL-6, IL-10, and lactate concentrations were 197.2+/-28.4 (mean +/- SEM), 71.1+/-10.1 pg/mL, and 46.7+/-9.4 mg/dL at entry. These concentrations were significantly decreased at day 4. The ratio of IL-6 to IL-10 was 3.11+/-0.47 at entry and was significantly correlated with ISS (r=.872, P<.01), APACHE II score (r=.887, P<.01). The IL-10, IL-6, and lactate concentrations were elevated immediately after major trauma, and the ratio of IL-6 to IL-10 was correlated with injury severity. This suggests that the ratio of IL-6 to IL-10 may be used to predict the injury severity after trauma.

Change in the ratio of interleukin-6 to interleukin-10 predicts a poor outcome in patients with systemic inflammatory response syndrome.

OBJECTIVE: To examine whether changes in interleukin (IL)-6 and IL-10 concentrations in patients with systemic inflammatory response syndrome (SIRS) can predict a poor outcome. DESIGN: Prospective study. SETTING: Emergency and intensive care unit of a medical school hospital. PATIENTS: Twenty-five patients who fulfilled the criteria for SIRS. INTERVENTIONS: Blood samples were collected for cytokine determinations. MEASUREMENTS AND MAIN RESULTS: IL-6 and IL-10 concentrations were measured by enzyme-linked immunosorbent assay in plasma samples. Blood samples were obtained at 0, 1, 2, and 4 days from patients who fulfilled the criteria for SIRS. Of 25 patients, 19 survived and the other six patients died of multiple organ failure. Although IL-6 and IL-10 concentrations in survivors decreased gradually from 186.1 +/- 34.4 to 93.6 +/- 18.9 (SEM) pg/mL (p < .05) and from 77.4 +/- 21.2 to 32.0 +/- 11.8 pg/mL (p < .05), IL-6 concentrations in nonsurvivors did not. Although the ratio of IL-6 to IL-10 in survivors was almost stable, the ratio in nonsurvivors increased from 5.5 +/- 3.1 to 18.7 +/- 2.8 (p < .05). Multivariate analysis showed that when heart rate, mean arterial pressure, IL-6, IL-10, and the ratio of IL-6 to IL-10 were taken into account, there only remained a relationship between the ratio of IL-6 to IL-10 and outcome. CONCLUSIONS: In nonsurvivors, IL-6 concentrations did not decrease, IL-10 concentration decreased, and the ratio of IL-6 to IL-10 increased. An increase in the ratio of IL-6 to IL-10 indicated a correlation with a poor outcome.

Corticosteroid effect on early beta-adrenergic down-regulation during circulatory shock: hemodynamic study and beta-adrenergic receptor assay.

OBJECTIVES: The steroid effect on critically ill patients remains controversial. The aim of this study is to characterize the effect of methylprednisolone on the heart in a beta-adrenergically down-regulated condition. DESIGN: A prospective hemodynamic study and retrospective receptor assay. SETTING: Multidisciplinary ICU in a university hospital. SUBJECTS: 42 patients who required pulmonary arterial catheters and an additional 4 corpses who were available for study within 3 h of their deaths. INTERVENTION: Intravenous methylprednisolone (10 mg/kg). MEASUREMENTS AND RESULTS: We pursued a hemodynamic study following a glucocorticoid administration. In patients who had undergone a long term (> 72 h) catecholamine treatment, the cardiac index increased. In patients who had undergone a short term (1-72 h) catecholamine treatment and in patients with no record of catecholamine administration, the cardiac index showed no remarkable change. Among the corpses, who died soon after their arrival, and the patients, who later died in the ward and were available for further study, we measured beta-adrenergic receptor density in the left ventricular myocardium. It was found that receptor density was decreased after long term catecholamine treatment. Methylprednisolone, on the other hand increased the receptor density. CONCLUSION: Methylprednisolone improved the cardiac index, intriguingly, in patients with long term catecholamine treatment in circulatory shock. Myocardial beta-adrenergic receptor also increased in number after the administration of methylprednisolone. However, the hemodynamic improvement caused by methylprednisolone was not observed in patients without beta-adrenergic down-regulation.

Specific hepatocyte endothelin receptors and the direct effect of endothelin on protein synthesis.

High affinity binding sites for endothelin (ET)-1 were identified on mouse parenchymal hepatocytes. The binding of 125I-ET-1 at its site was specific, saturable, and time dependent, but dissociation of the receptor-bound ligand was minimal. Scatchard analysis of the binding data revealed the presence of a non-interacting, single class of high-affinity binding sites on hepatocytes. The dissociation binding constant (Kd) and the maximal binding capacity (Bmax) were determined as 2.1 x 10(-10) M and 3.0 x 10(2) sites/cell, respectively. Unlabeled ET-1 competitively inhibited the binding of 125I-ET-1 to primary cultured mouse hepatocytes with a concentration for half-maximal inhibition (IC50) of 2.0 x 10(-10) M. ET-1 apparently enhanced total protein synthesis in primary cultured mouse hepatocytes concentration ranging from 3 x 10(-11) M to 3 x 10(-8) M in a dose-dependent manner. These data indicate that specific receptor for ET-1 is present in the mouse liver and suggest for the first time that hepatocyte protein synthesis is involved in its direct, agonistic effect.

[Therapeutic goals for fluid management in profound shock].

The therapeutic goals for fluid replacement in 9 patients were studied. Five cases in sepsis, 2 in necrotizing pancreatitis and 2 in fat embolism were treated as dehydration or hypovolemia. Fluid replacement was performed with the view of obtaining the amelioration of circulation and urine output, even if CVP or PCWP had been elevated on admission. The values of CVP and PCWP, renal function and pulmonary function were assessed retrospectively. Out of 9 patients, one died of refractory shock, brain edema due to fat embolism and remaining one after recovery of shock. Out of 6 survivors, 2 showed oliguric renal failure, and 2 nonoliguric renal failure. The volume of administered fluid ranged from 5445 ml/10 hrs to 15820 ml/14 hrs and speeds of fluid administration were 545 ml/hr to 1248 ml/hr. CVP value on admission ranged from 4.0 to 22.0 cmH2O (3.0 to 16.3 mmHg), mean value 14.0 +/- 6.5 cmH2O. Through the course, the highest CVP and PCWP ranged from 12.5 to 26.5 (mean 19.8) mmHg and 14 to 36 (mean 20.9) mmHg, respectively. Out of 9 patients, 8 were suffering from respiratory distress, however, 7 recovered by PEEP except for one refractory shock. High values of CVP or PCWP could be recognized even if in hypovolemic shock and/or septic shock. Maintenance of higher values (18-20 mmHg) in CVP and/or PCWP during fluid resuscitation might be recommended because adequate fluid resuscitation could sustain the renal function, and result in good outcome.