HLA-A*31:01 and different types of carbamazepine-induced severe cutaneous adverse reactions: an international study and meta-analysis.

HLA-A*31:01 was reported to be associated with carbamazepine (CBZ)-induced severe cutaneous adverse reactions (SCAR), including drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). We conducted an international study using consensus diagnosis criteria to enroll a total of 93 patients with CBZ-SCAR from Europe or Asia. We found that HLA-A*31:01 showed a significant association with CBZ-DRESS in Europeans (P<0.001; odds ratio (OR) (95% confidence interval (CI))=57.6 (11.0-340)), and the strong association was also found in Chinese (P<0.001; OR (95% CI)=23.0 (4.2-125)). However, HLA-A*31:01 had no association with CBZ-SJS/TEN in neither Chinese nor Europeans. By comparison, HLA-B*15:02 showed a strong association with CBZ-SJS/TEN in Chinese (P<0.001, OR (95% CI)=58.1 (17.6-192)). A meta-analysis of this and other published studies confirmed that in all populations, HLA-A*31:01 had an extremely strong association with CBZ-DRESS (P<0.001, a pooled OR (95% CI)=13.2 (8.4-20.8)), but a much weaker association with CBZ-SJS/TEN (P=0.01, OR (95% CI)=3.94 (1.4-11.5)). Our data revealed that HLA-A*31:01 is a specific predictor for CBZ-DRESS but not for CBZ-SJS/TEN. More studies are needed to investigate the genetic determinant of CBZ-SJS/TEN in Europeans. Considering the potential clinical utility, the cost-effectiveness of the combined HLA-A*31:01 and HLA-B*15:02 genetic test to prevent CBZ-SCAR in Chinese needs further investigation.

Primary sternal osteomyelitis due to Peptostreptococcus anaerobius.

Primary sternal osteomyelitis (PSO) is a rare syndrome. In adults, it usually occurs with underlying predisposing factors, such as immunodeficiency, or intravenous (IV) drug abuse. The infecting organism in these patients is usually Staphylococcus aureus or Pseudomonas aeruginosa. Peptostreptococcus species are Gram-positive anaerobic cocci and are part of the normal flora of human mucocutaneous surfaces. Peptostreptococcus infection can occur in all body sites, including the central nervous system, head, neck, chest, abdomen, pelvis, skin, bone, joint, and soft tissue. Here, we report on a 32-year-old previously healthy Chinese man who was diagnosed with PSO and P. anaerobius was yielded in the bacterial culture. He was treated empirically with antibiotics, but these failed. After additional limited surgical intervention with debridement, the PSO was cured.

Atypical ductal hyperplasia of the breast diagnosed by ultrasonographically guided core needle biopsy.

PURPOSE: We analysed the ultrasonographic (US) features of atypical ductal hyperplasia (ADH) of the breast diagnosed by US-guided core needle biopsy (CNB) with the aim of identifying factors that affect the underestimation of ADH. MATERIALS AND METHODS: A total of 134 ADH lesions sampled by US-guided CNB were reviewed retrospectively. All lesions were evaluated for pattern, size, lesion characteristics and margins, and the corresponding surgical outcome or imaging follow-up was obtained. Each patient's clinical and radiological features were analysed to identify factors involved in ADH underestimation. RESULTS: The prevalence of malignancy in each pattern of lesions following surgical excision was 32/81 (40%) for solid masses, 14/31 (45%) for ductal patterns, 5/17 (29%) for complex cystic lesions and 2/5 (40%) for architectural distortions. Based on the results of surgical and US follow-up, none of the category 3 lesions was proven to be a malignancy. Malignancy was found in 17 (21%) of the 80 BI-RADS (Breast Imaging Reporting and Data System) category 4a lesions, 20 (74%) of the 27 category 4b lesions, 12 (92%) of the 13 category 4c lesions, and four (100%) of the four category 5 lesions. Lesions with a higher US assessment category, lacking circumscribed margins, or a mammographic finding of suspected malignancy were all significantly associated with underestimation (p < 0.05 for each). CONCLUSION: US is useful in evaluating ADH lesions and in clarifying the indication for biopsy of these lesions. Familiarity with the frequency associated with malignancy for each feature will improve the utility of US in the work-up of these breast abnormalities.

Use of therapeutic responses to glucose replacement to predict glucose patterns in diabetic patients presenting with severe hypoglycaemia.

OBJECTIVE: The purpose of this study was to determine whether initial serum glucose levels, therapeutic responses to intravenous glucose replacement and changes in serum glucose levels over time could predict serum glucose patterns. METHODS: The patients enrolled in this retrospective chart review had been previously diagnosed with diabetes mellitus and were later hospitalised for severe hypoglycaemia (SH). They were all admitted to the emergency department (ED) during a 4-year period between January 2003 and December 2006. Comparison of the therapeutic responses to glucose replacement according to the serum glucose patterns [categorised into recurrent hypoglycaemia (RH), overshoot hyperglycaemia (OH) and favourable groups] during the first 48 h was performed. RESULTS: Compared with the favourable group, therapeutic responses to glucose replacement were significantly lower in the RH group and higher in the OH group; the changes in serum glucose levels over time were also significantly lower in the RH group and higher in the OH group. CONCLUSION: Therapeutic responses to glucose replacement and changes in serum glucose levels over time can differentiate diabetic patients with RH and OH from those with favourable glucose patterns during the first 48 h after presentation in the ED with SH. We believe that a 'response-to-treatment' based strategy is useful in determining the ED disposition of diabetic patients presenting with SH.

Valproic acid attenuates the risk of acute respiratory failure in patients with subarachnoid hemorrhage.

BACKGROUND: Valproic acid (VPA) has shown potent anti-inflammatory effect and attenuates acute lung injury. AIM: To determine whether the use of VPA is associated with a decreased risk of acute respiratory failure (ARF) in patients with subarachnoid hemorrhage (SAH). DESIGN: The Taiwan National Health Insurance Research Database was used to analyse all patients newly diagnosed with SAH from 2000 to 2010. The VPA users were matched for age, gender and index date in 1:2 ratios with randomly selected non-VPA users as a comparison group. METHODS: Multivariate Cox regression was used to identify the predictors of ARF and to compare the incidence rates of ARF among SAH patients using and not using VPA. RESULTS: The study cohort included 16 228 newly diagnosed SAH patients, from which 521 VPA users and 1042 matched non-VPA-exposed individuals were selected. In the VPA-treated cohort and the non-VPA-treated cohort, 117 and 289 patients developed ARF, respectively. Any use of VPA was associated with a 16% decreased risk of ARF requiring mechanical ventilation in 30-day tracking of the SAH patients (adjusted hazard ratio [HR], 0.840, 95% confidence interval [CI], 0.676-0.945). Age, sepsis and pneumonia were identified as independent predictors of ARF in patients with SAH. After stratification, VPA users showed a lower risk of ARF among SAH patients complicated with pneumonia compared with non-users of VPA (adjusted HR, 0.816, 95% CI, 0.652-0.921). CONCLUSIONS: Any use of VPA was associated with a reduced risk of ARF in patients with SAH. VPA may be beneficial for decreasing the risk of pneumonia-induced ARF in patients with SAH.

Splenic infarction: an unrecognized cause of culture-negative peritonitis in a continuous ambulatory peritoneal dialysis patient.

The appearance of cloudy peritoneal dialysis effluent in combination with the clinical manifestations of peritonitis usually heralds infectious peritonitis and the diagnosis is established with routine cultures. However, patients may present with culture-negative cloudy dialysate effluent and after ruling out atypical infectious etiologies, other intraabdominal causes should be considered in the differential diagnosis. A 57-year-old male with uremia on continuous ambulatory peritoneal dialysis with a pertinent history of restrictive cardiomyopathy and chronic atrial fibrillation suffered from abdominal pain and persistent culture-negative cloudy peritoneal dialysate. Clinical improvement was limited after empiric antibiotic treatment and all bacteriologic workups were negative. Isolated spleen infarction, a rare cause of culture-negative peritonitis, was disclosed by abdominal computed tomography. Spleen infarction is still an unrecognized cause of culture-negative peritonitis and is frequently overlooked. A high degree of suspicion is needed in CAPD patients with thromboembolism risk who present with unexplained persistent abdominal pain and cloudy PD effluent.

Idiopathic syringomyelia: case report and review of the literature.

Syringomyelia is an uncommon disease that is caused most often by type I Chiari malformation, which develops in the hindbrain, and less frequently by other factors which are not limited to the hindbrain, including trauma, infection, or scoliosis. Idiopathic syringomyelia is rare. We present in this article a patient with idiopathic syringomyelia characterized by hypoesthesia and progressive weakness in the left lower limb. Decompression was attempted by means of laminectomy and a syringoarachnoid shunt. Motor, sensory, and bladder functions were monitored by the change in Japanese Orthopedic Association scores, which increased from 10 points preoperatively to 14 points 30 days postoperatively. This case demonstrates the effectiveness of surgical decompression in a patient with remarkable neurological deficit.

Listerial meningitis in a patient with undiagnosed acquired immunodeficiency syndrome: ampicillin should be added to the empirical antibiotic coverage.

Meningitis is an important differential diagnosis in patients with fever, headache, and/or altered consciousness in the emergency department (ED). With human immunodeficiency virus (HIV) infection becoming increasingly common, patients with acquired immunodeficiency syndrome (AIDS) need to be recognised promptly to facilitate the choice of appropriate antibiotic therapy for potential opportunistic infections. Physicians should be able to recognise a patient with undiagnosed AIDS who presents to the ED and perform further confirmational tests without violating the rights of the patient. Additional tests focusing on discovering potential opportunistic pathogens should be performed. Ampicillin should be added to the empirical regimen for the coverage of Listeria meningocerebritis, which should be considered in all potentially immunocompromised hosts with suggestive clinical presentations. Failure to recognise patients with AIDS and provide antibiotics active against L monocytogenes in such hosts may lead to a catastrophic outcome.

Alternative activation of extracellular signal-regulated protein kinases in curcumin and arsenite-induced HSP70 gene expression in human colorectal carcinoma cells.

We have investigated the regulation mechanism of chemical stress-induced HSP70 gene expression in human colorectal carcinoma cells (COLO205 and HT29). Our data show that chemical treatments including sodium arsenite and curcumin, induced significant synthesis of HSP70 and its mRNA. The induced HSP70 gene expression appears to be increased at the transcriptional level. The increase in HSP70 gene expression by both chemicals is associated with an increase in HSF binding to HSE and induction of HSF1 di- or trimerization. Phosphorylation and activation of extracellular signal-regulated proteins (ERK1/2) were detected in sodium arsenite-treated COLO205 and HT29 cells, and the free radical scavenger N-acetyl-L-cysteine (NAC) was able to inhibit this ERK1/2 activation and HSP70 gene expression. MAPK blockade by the specific MEK1 inhibitor (PD98059) decreased the ability of sodium arsenite to increase HSP70 gene expression in a dose-dependent manner along with dephosphorylation of ERK1/2 proteins. In contrast to arsenite treatment, activation of ERK1/2 was not detected in curcumin-treated colorectal carcinoma cells, and NAC and PD98059 did not show any inhibitory effect on HSP70 gene expression induced by curcumin. Overexpression of a dominant negative mutant of mitogen-activated protein kinase kinase kinase 1 (MEKK1-DN) prevents arsenite-induced ERK1/2 phosphorylation and HSP70 protein synthesis. These results indicated that the ERK signaling pathway can participate in HSP70 gene expression induced by the prooxidant sodium arsenite, but not by the antioxidant curcumin.

Suppression of inducible cyclooxygenase and nitric oxide synthase through activation of peroxisome proliferator-activated receptor-gamma by flavonoids in mouse macrophages.

Peroxisome proliferator-activated receptor (PPAR)gamma transcription factor has been implicated in anti-inflammatory response. Of the compounds tested, apigenin, chrysin, and kaempferol significantly stimulated PPAR gamma transcriptional activity in a transient reporter assay. In addition, these three flavonoids strongly enhanced the inhibition of inducible cyclooxygenase and inducible nitric oxide synthase promoter activities in lipopolysaccharide-activated macrophages which contain the PPAR gamma expression plasmids. However, these three flavonoids exhibited weak PPAR gamma agonist activities in an in vitro competitive binding assay. Limited protease digestion of PPAR gamma suggested these three flavonoids produced a conformational change in PPAR gamma and the conformation differs in the receptor bound to BRL49653 versus these three flavonoids. These results suggested that these three flavonoids might act as allosteric effectors and were able to bind to PPAR gamma and activate it, but its binding site might be different from the natural ligand BRL49653.

Cerebral arterial innervation: II. Development of calcitonin-gene-related peptide and norepinephrine in the rat.

The pre- and postnatal development of trigeminal calcitonin-gene-related peptide (CGRP)- and sympathetic norepinephrine (NE)-containing nerves supplying the cerebral arteries was studied with immunohistochemistry in rats. At 18-19 days in utero (E 18-19), CGRP fibers were present only as one or two longitudinal bundles zigzagging along the anterior cerebral artery and anterior communicating artery. Growth-cone-like swellings were found at the terminals of individual fibers. In contrast, at this same prenatal age NE fibers were present as a meshwork on all cerebral arteries. The density of NE fibers was higher in the rostral than in the caudal parts of the circle of Willis; growth cones were present on individual fibers at the middle segment of the basilar artery and distal parts of major cerebral arteries. At postnatal day 1-2 (PND 1-2; date of birth = PND 1), the outgrowth of CGRP axons extended along the walls of the middle cerebral and internal carotid arteries. These axons were relatively straight and unbranched. At the same time, NE fibers increased in number and density and continued to form the meshwork pattern on all cerebral arteries. At the end of the first postnatal week, all the longitudinal NE bundles on the rostral part of the circle of Willis began to form circular arborizations. At the end of the second postnatal week, the pattern of NE innervation had completely changed, consisting almost entirely of circumferential rather than tangential fibers. Beginning in the first postnatal week, CGRP fibers increased greatly in number and density and began to form a meshwork pattern. At the second postnatal week, the pattern of CGRP innervation, compared to the pattern at fetal and neonatal stages, had changed significantly, consisting predominantly of a meshwork pattern. By 4 weeks after birth, both the NE and CGRP fiber systems achieved adult densities and patterns. The present results demonstrate the following: 1) Both sympathetic-NE and trigeminal-CGRP innervation of cerebral arteries begin in utero; the NE system innervates corresponding parts of the vessels earlier than the CGRP system. 2) Both NE and CGRP fibers are more dense in the rostral than in the caudal segments of the circle of Willis; this rostrocaudal gradient is expressed in both density and pattern by the earliest fibers of both neurochemical systems and is maintained throughout all developmental stages.(ABSTRACT TRUNCATED AT 400 WORDS)

Cerebral arterial innervation by nerve fibers containing calcitonin gene-related peptide (CGRP): I. Distribution and origin of CGRP perivascular innervation in the rat.

The origin, density and distribution of calcitonin gene-related peptide (CGRP) immunoreactivity in cerebral perivascular nerves and the trigeminal ganglion of rats were examined in this study. CGRP immunoreactive axons were abundant on the walls of the rostral circulation of the major cerebral arteries in the circle of Willis. The fibers form a grid- or meshwork of longitudinal and circumferential axons studded with numerous varicose swellings. The density of CGRP fibers was particularly high at the bifurcation of major arteries. A few CGRP fibers cross the midline to innervate arteries on the contralateral side of the arterial tree. The arteries of the caudal circulation were sparsely innervated by CGRP fibers. In the trigeminal ganglion, about 30% of the ganglion cells had CGRP immunoreactivity. The cell size of most (75%) of CGRP neurons was less than 30 micron in diameter. There was no significant difference in staining density between small and large CGRP neurons. Unilateral transection of the maxillary and mandibular divisions of the trigeminal nerve caused a substantial decrease of CGRP immunoreactivity in the ipsilateral dorsal two-thirds of the trigeminal nucleus and cervical spinal cord but did not noticeably change the diameter of the vascular lumen or the densities of CGRP fibers in the walls of the cerebral arteries. In contrast, unilateral transection that included the ophthalmic division eliminated CGRP fibers on the ipsilateral cerebral arteries and eliminated CGRP immunoreactivity throughout the trigeminal nucleus in the brainstem and rostral cervical cord. In addition, these lesions caused a significant reduction in the diameter of the denervated arteries. The present study demonstrates that CGRP, a putative neurotransmitter/neuromodulator, is especially abundant in the rostral cerebral circulation and is derived from the ipsilateral ophthalmic division of the trigeminal nerve. In addition, the loss of CGRP perivascular nerves is associated with a reduction of the arterial lumen. This suggests that CGRP is a strong candidate as a nerve-derived trophic factor at trigeminal terminals and provides additional evidence that CGRP is a component in the trigeminovascular system influencing vascular diameter.

Cholecystokinin acts through catecholaminergic mechanisms in the hypothalamus to influence ingestive behaviour in the rat.

Administration of cholecystokinin (CCK) (0.2 - 0.6 micrograms in a volume of 2 microliter) into the lateral cerebral ventricle caused a decrease in intake of food but a relative increase in intake of water (or water-to-food ratio) in rats. To determine whether the anorexic actions of CCK were mediated through the hypothalamic nuclei, rats were infused with CCK (0.02 - 0.12 microgram in a volume of 0.5 microliter) through previously implanted hypothalamic cannulae. Administration of CCK into the lateral hypothalamus, but not the anterior hypothalamus or ventromedial hypothalamus, caused decreased intake of food and a relative increased intake of water. In addition, the responses induced by injection of CCK into the hypothalamus were completely abolished by selective depletion of catecholamines in the hypothalamus (eg. noradrenaline and dopamine) with intra-hypothalamic injection of 6-hydroxydopamine. Intraperitoneal administration of 0.12 microgram of CCK had no effect on the intake of food and water in rats. The data indicate that CCK acts through catecholaminergic mechanisms in the hypothalamus to influence feeding behaviour.

Suppression of nitric oxide synthase and the down-regulation of the activation of NFkappaB in macrophages by resveratrol.

Resveratrol, naringenin and naringin are naturally occurring flavonoids in grapes and grapefruits. The anti-inflammatory effects of these flavonoids have been well documented, but the mechanism is poorly characterized. High concentration of NO are produced by inducible NO synthase (iNOS) in inflammation, and the prevention of the expression of iNOS may be an important anti-inflammatory mechanism. In this study, the effects of these flavonoids on the induction of NO synthase (NOS) in RAW 264.7 cells activated with bacterial lipopolysaccharide (LPS, 50 ng ml(-1)) were investigated. Resveratrol was found strongly to inhibit NO generation in activated macrophages, as measured by the amount of nitrite released into the culture medium, and resveratrol strongly reduced the amount of cytosolic iNOS protein and steady state mRNA levels. However, the inhibitory abilities of naringenin were lower, and the inhibitory abilities of naringin were almost negligible. In electrophoretic mobility shift assays, the activation of NFkappaB induced by LPS for 1 h was inhibited by resveratrol (30 microM). Furthermore, in immunoblotting analysis, cells treated with LPS plus resveratrol showed an inhibition of phosphorylation as well as degradation of IkappaBalpha, and a reduced nuclear content of NFkappaB subunits. The flavonoids may be of value for inhibiting the enhanced expression of iNOS in inflammation through down-regulation of NFkappaB binding activity.

Comparison of the MB/BacT and BACTEC MGIT 960 system for recovery of mycobacteria from clinical specimens.

A total of 543 specimens were cultured in parallel with the MB/BacT and BACTEC MGIT 960 systems and on the conventional solid media. Mycobacteria were identified from 95 (17.5%) specimens, including 63 (66.3%) Mycobacterium tuberculosis and 32 (33.7%) nontuberculous mycobacteria. The recovery rates for the MB/BacT, MGIT 960, and solid media were 91.6, 87.4, and 54.7%, respectively, for all mycobacteria; the recovery rates were 93.6, 88.9, and 63.4%, respectively, for M. tuberculosis complex alone, and 87.5, 84.4, and 37.5%, respectively, for all nontuberculous mycobacteria. The mean times to detection of all mycobacteria by individual systems were 13. 9, 8.7, 31.7 days for the MB/BacT, MGIT 960 and solid media, respectively, 13.9, 9.3, 32.9 days for M. tuberculosis alone, and 14. 1, 8.1, 27.2 days for all nontuberculous mycobacteria. The contamination rates of the MB/BacT and MGIT 960 were 10.2 and 5.4%, respectively. With regard to detection times and recovery rates, both automated systems are superior to the conventional media (all p < 0.005). As compared to the MB/BacT, the MGIT 960 detected mycobacterial growth more rapidly (p < 0.001), and had a lower contamination rate (p = 0.003); however, there was no statistically significant difference in recovery rates between these two systems. These results indicate that both MGIT 960 and MB/BacT systems are rapid, sensitive, and efficient methods for the recovery of mycobacteria from clinical specimens.

Diagnostic strategy in evaluation of renal abscess.

The diagnosis of renal abscess is still a challenging problem. Early manifestations are usually nonspecific and nonlocalizing. Clinical picture, laboratory data, and intravenous pyelogram do not always differentiate between inflammatory lesions and neoplastic processes. Two cases with bilateral, metachronous renal abscesses are presented. The use of 111Indium scan is probably the major recent advance used for unmasking this inflammatory lesion. Sonography, computerized tomography scan, and even arteriography are sometimes necessary to establish reliable preoperative diagnosis. The diagnostic strategy for a systematic approach to the lesion is outlined.

Theaflavin-3,3'-digallate from black tea blocks the nitric oxide synthase by down-regulating the activation of NF-kappaB in macrophages.

Nitric oxide (NO) plays an important role in inflammation and also in multiple stages of carcinogenesis. We investigated the effects of various tea polyphenols, including theaflavin, a mixture of theaflavin-3-gallate and theaflavin-3'-gallate, theaflavin-3,3'-digallate, thearubigin, and (-)-epigallocatechin-3-gallate on the induction of NO synthase in lipopolysaccharide-activated murine macrophages, RAW 264.7 cells. Theaflavin-3,3'-digallate was found to be stronger than (-)-epigallocatechin-3-gallate in inhibiting NO generation and inducible NO synthase protein in activated macrophages, while theaflavin, a mixture of theaflavin-3-gallate and theaflavin-3'-gallate and thearubigin were less effective. Inhibition of NO production was observed when cells were cotreated with theaflavin-3,3'-digallate and lipopolysaccharide. Western blot and reverse transcriptase-polymerase chain reaction (RT-PCR) analyses demonstrated that significantly reduced 130-kDa protein and mRNA levels of inducible NO synthase were expressed in lipopolysacchride-activated macrophages with theaflavin-3,3'-digallate, compared to those without theaflavin-3,3'-digallate. Electrophoretic mobility shift assay (EMSA) indicated that theaflavin-3,3'-digallate blocked the activation of nuclear factor kappaB (NF-kappaB), a transcription factor necessary for inducible NO synthase induction. Theaflavin-3,3'-digallate also blocked phosphorylation of IkappaB from cytosolic fraction and reduced lipopolysacchride-induced nuclear accumulation of transcription factor NF-kappaB p65 and p50 subunits. These results suggest that theaflavin-3,3'-digallate decreases the protein levels of inducible NO synthase by reducing the expression of inducible NO synthase mRNA, and the reduction could be via preventing the activation of NF-kappaB, thereby inhibiting the induction of inducible NO synthase transcription. It was also demonstrated that the gallic acid moiety of theaflavin-3,3'-digallate is essential for their potent anti-inflammation activity.

Development of cerebral arterial innervation: synchronous development of neuropeptide Y (NPY)- and vasoactive intestinal polypeptide (VIP)-containing fibers and some observations on growth cones.

The pre- and postnatal development of sympathetic fibers containing neuropeptide Y (NPY) and parasympathetic fibers containing vasoactive intestinal polypeptide (VIP) supplying the cerebral arteries were studied with immunohistochemistry in rats. The innervation patterns and densities of NPY and VIP fibers were similar at all stages of development and similar to that previously reported for norepinephrine (NE). There was a striking reorganization of the innervation pattern of all three fiber systems between the first and second postnatal weeks. At all stages of development prior to the first postnatal week, growth cones were present on individual fibers at the distal part of major cerebral arteries and the middle segment of the basilar artery. The growth cones had a range of shapes from blunt to stellate, lanceolate or filiform. NPY and VIP immunoreactive granules were commonly present. The present results taken with our earlier developmental study of NE fibers (J. Comp. Neurol., 271 (1988) 435-444), demonstrate that: (1) both sympathetic and parasympathetic perivascular nerves on immature cerebral vessels develop with similar sequences: first longitudinal fibers and fiber bundles are present; these transform to a meshwork pattern and finally transform again into the mature, predominantly circumferential pattern; (2) both the classical (NE) and peptidergic transmitters (NPY) within the sympathetic system appear to develop identically in terms of time of appearance, innervation patterns, densities and reorganization.(ABSTRACT TRUNCATED AT 250 WORDS)

Retrograde localization of the innervation of the middle cerebral artery with horseradish peroxidase in cats.

The innervation of the middle cerebral artery (MCA) of the cat was studied by applying horseradish peroxidase (HRP) to the wall of the right MCA. After a survival period of 48 to 72 hours, the bilateral superior cervical ganglia, middle cervical ganglia, stellate ganglia, T-4 sympathetic paravertebral ganglia, geniculate ganglia, semilunar ganglia, nodose ganglia, and brain stem including midbrain, pons, and medulla oblongata were removed to be processed with tetramethyl benzidine. HRP-labeled neurons were found in the ipsilateral superior cervical ganglion, semilunar ganglion, and dorsal raphe nucleus. The other areas did not have HRP activity. The results suggest that the adrenergic nerves innervating the MCA originate in the ipsilateral superior cervical ganglion, the sensory nerves originate in the ipsilateral semilunar ganglion, and the serotonergic nerves originate in the ipsilateral dorsal raphe nucleus. Cerebral arterial constriction may relate to the intrinsic (intracerebral) neurogenic pathway involving the trigeminal nerve and the dorsal raphe nucleus.

Traumatic intracavernous carotid aneurysm with massive epistaxis.

Five cases of traumatic intracavernous carotid aneurysm are presented. All of the patients were young men with a history of severe head injury. The clinical manifestations were massive epistaxis and an ipsilateral cavernous sinus syndrome. The diagnosis was made correctly by carotid angiography. All of the patients developed another episode of massive epistaxis after admission. Emergency trapping of the internal carotid artery was performed. An urgent rescue method was used in one of our patients to prevent exsanguination before definitive surgical treatment. One patient died of exsanguination in spite of emergency ligation of the internal carotid artery. In the other four patients, no epistaxis was experienced after the operation.