Implications of Clostridium septicum in Vascular Surgery: A Case Report and Outcomes Literature Review.

Clostridium septicum is a rare organism, accounting for approximately 1.3% of clostridial infections and is associated with synchronous colonic malignancy. This case report describes a patient successfully treated for a mycotic aortic aneurysm secondary to C. septicum bacteremia. Subsequent evaluation confirmed a colonic malignancy, prompting early intervention. A systematic literature review revealing a rate of gastrointestinal malignancy in this patient population is 71%, and hematologic malignancy is 3.9%, with the remaining cohort of patients having an unknown source. Infectious involvement of the aorta and associated vascular structures portends a poor prognosis with a 57% mortality rate. Our case and updated review demonstrates the implications of C. septicum vascular seeding and subsequent treatment outcomes.

Neurologic Symptoms Caused by Mature Cystic Teratoma of the Thymus.

This case report describes an unusual presentation of a rare mature cystic teratoma of the thymus. It was indistinguishable from other anterior mediastinal masses without surgical resection and histologic diagnosis. Malignant thymic masses and mediastinal masses that cause compression of the heart and surrounding vessels have been reported to cause paresthesia. However, this case documents a mediastinal teratoma, specifically a benign thymic teratoma, that presented with symptoms of sensory dysfunction among other neurologic deficits. Complete surgical resection of the teratoma was performed without complications, and all symptoms resolved.

Microliths in the parotid of ferret investigated by electron microscopy and microanalysis.

The present investigation is an attempt to determine the occurrence, elemental composition and formation of microliths in the parotid of ferret. Parotids from four normal ferrets were examined by electron microscopy and X-ray microanalysis. Crystalline microliths were found in phagosomes of acinar cells, which occasionally contained secretory material, and in phagosomes situated between mitochondria of striated ductal cells. Crystalline microliths and microliths that consisted of granular material either without crystals or mixed with a component of crystals were found in lumina, where they were often associated with cellular debris. The crystals contained calcium and phosphorus. Phagy and stagnation related to pockets of inefficient secretory activity have been previously found to be features of the parotid of ferret. Thus, possibly persistent degradation of redundant cellular material, particularly secretory granules, in phagosomes results in accumulation of calcium and leads to calcified microliths, whereas consolidation of stagnant debris extracellularly does not involve such accumulation and leads to non-calcified or mixed microliths.

Innervation and secretory function of transplanted human submandibular salivary glands.

Free submandibular gland autotransplantation is used to treat absolute tear deficiency. Although disconnected from any peripheral innervation, most transplants show increasing secretion for years. We have evaluated the secretory activity and autonomic innervation of such transplants. Secretory activity of glands in response to parasympatholytics and parasympathomimetics was evaluated by Schirmer's test and Technetium scintigraphy. Submandibular gland tissue specimens taken before and after transplantation were examined histologically. Relative hypersecretion during the first postoperative week suddenly decreased but then slowly increased during the first postoperative year. Hypersecretion was significantly reduced by parasympatholytics while carbachol rapidly increased secretion. Histology of transplanted glandular tissue showed parenchymal atrophy. Cholinesterase-positive nerves were abundant and in a similar distribution to normal with scattered positive ganglion cells. Adrenergic axons were fewer than normal and irregularly distributed. Early hypersecretion may be due to release of neurotransmitters from degenerating terminal axons. This is followed by a period of minimal secretion during which hypersensitivity of acinar cells develops. With spontaneous reinnervation, secretion is accentuated by external sympathetic vasomotor adrenergic drive. This shows that submandibular glands can remain viable despite complete separation from their normal nerve supply and are capable of regaining a substantial secretory activity for years.

Microenvironmental adaptations in the parotid of ferret investigated by electron microscopy.

Previous histochemical investigations suggested that the microenvironment in the parotid of ferret would foster microlithiasis because of a combination of pockets of inefficient secretion, brisk phagy and secretory material rich in calcium. We have undertaken the present ultrastructural investigation in an attempt to provide corroborative evidence. Parotids from four normal ferrets were examined by electron microscopy. Phagosomes in which there was cellular debris and occasionally secretory granules were present in acinar cells, which indicates crinophagy, and residual bodies were present in ductal cells. Atrophic parenchymal cells, degenerate parenchymal cells and apoptotic bodies were present. Cellular debris and secretory material were present in lumina, which indicates stagnation. The results indicate that removal of redundant secretory material and cells and low flow of saliva are features of the parotid of ferret and support the concept of pockets of inefficient secretory activity.

Secretion of IgA by rat parotid and submandibular cells in response to autonomimetic stimulation in vitro.

The major antibody in saliva is IgA, which is actively transported by pIgR expressed by parenchymal cells within the salivary glands. The rate of IgA secretion into saliva is regulated by the autonomic nerves supplying the glands in vivo. This study examined the mechanism of increased IgA secretion into saliva with autonomimetic stimulation. In vitro stimulation of IgA secretion from cells prepared by digestion of rat salivary glands found submandibular cell preparations responded to alpha- and beta-adrenergic stimuli whereas the parotid cells responded only to beta-adrenergic stimulation, although cells from both glands responded similarly to cholinergic stimulation. The additional responsiveness of submandibular cells to alpha-adrenergic stimulation probably reflects the presence of granular duct cells (absent in parotid glands) which are known to secrete protein in response to high frequency sympathetic stimulation. The increased secretion of IgA was not dependant upon increased plasma cell activation since isolated salivary gland plasma cells did not respond to agonists. Further evidence for the regulating role of parenchymal cells in IgA secretion into saliva was revealed by analysis of polymeric immunoglobulin receptor (pIgR) levels expressed on cells. Following in vivo nerve stimulation, there was an increased amount of pIgR expressed on the membrane surface. This was functionally demonstrated in vitro by increased uptake of human IgA by acutely prepared rat salivary cells following stimulation by adrenaline, indicating increased mobilisation of pIgR with stimulation. This study confirms that salivary cells increase the delivery of IgA into saliva by a pIgR-mediated mechanism in response to autonomic stimulation.

Neural regulation of submandibular gland blood flow in the streptozotocin-diabetic rat: evidence for impaired endothelium-dependent vasodilatation.

Functional changes in vascular tone and reactivity arise early in diabetes, and endothelial dysfunction plays a central role in the development of these microvascular abnormalities. Blood flow in the rat submandibular gland is mainly under neural regulation, which is mediated in part via endothelium-dependent mechanisms. Given the role of the endothelium in regulating blood flow and the deleterious effects of diabetes on endothelial cell function, we hypothesised that diabetes would significantly impair neural regulation of submandibular gland vascular perfusion. Three weeks after the induction of streptozotocin diabetes continuous 2 Hz sympathetic stimulation resulted in a similar degree of vasoconstriction (as measured by a decrease in perfusion) in both diabetic (-31+/-17%) and control rats (-22+/-7%). However, the magnitude and the duration of the after-dilatation were significantly less in diabetic animals. The same number of impulses delivered at 20 Hz in bursts (1s in every 10s) also resulted in vasoconstriction with each burst, but unlike the effects of burst stimulation in control rats the initial vasoconstriction was not converted to a net vasodilatation between bursts. Parasympathetic stimulation (2, 5 and 10 Hz) caused a marked vasodilatation in both control and diabetic rats, but the initial responses were delayed in diabetic animals, the maintained phases were smaller in magnitude (P<0.02) and it took longer to return to resting levels. In conclusion, submandibular gland vascular responses are altered in streptozotocin-induced diabetic rats. Vasoconstrictor responses evoked by sympathetic impulses were unaffected, but vasodilatory responses, particularly those associated with endothelium-dependent mechanisms, were significantly reduced.