Patterns of renal and splanchnic sympathetic vasomotor activity in an animal model of survival to experimental sepsis

Sepsis causes long-term disability, such as immune dysfunction, neuropsychological disorders, persistent inflammation, catabolism, and immunosuppression, leading to a high risk of death in survivors, although the contributing factors of mortality are unknown. The purpose of this experimental study in rats was to examine renal (rSNA) and splanchnic (sSNA) sympathetic nerve activity, as well as baroreflex sensitivity, in acute and chronic post-sepsis periods. The rats were divided into two groups: control group with naïve Wistar rats and sepsis group with 2-mL intravenous inoculation of Escherichia coli at 108 CFU/mL. Basal mean arterial pressure, heart rate, rSNA, sSNA, and baroreflex sensitivity were evaluated in all groups at the acute (6 h) and chronic periods (1 and 3 months). Basal rSNA and sSNA were significantly reduced in the surviving rats, as was their baroreflex sensitivity, for both pressor and hypotensive responses, and this effect lasted for up to 3 months. A single episode of sepsis in rats was enough to induce long-term alterations in renal and splanchnic sympathetic vasomotor nerve activity, representing a possible systemic event that needs to be elucidated. These findings showed that post-sepsis impairment of sympathetic vasomotor response may be one of the critical components in the inability of sepsis survivors to respond effectively to new etiological illness factors, thereby increasing their risk of post-sepsis morbidity.

Endoscopic versus open release in patients with de Quervain's tenosynovitis: a randomised trial.

The purpose of this study was to compare the outcome and complications of endoscopic versus open release for the treatment of de Quervain's tenosynovitis. Patients with this condition were randomised to undergo either endoscopic (n = 27) or open release (n = 25). Visual Analogue Scale (VAS) pain and Disabilities of Arm, Shoulder, and Hand (DASH) scores were measured at 12 and 24 weeks after surgery. Scar satisfaction was measured using a VAS scale. The mean pain and DASH scores improved significantly at 12 weeks and 24 weeks (p < 0.001) in both groups. The scores were marginally lower in the endoscopic group compared to the open group at 12 weeks (p = 0.012 and p = 0.002, respectively); however, only the DASH score showed a clinically important difference. There were no differences between the groups at 24 weeks. The mean VAS scar satisfaction score was higher in the endoscopic group at 24 weeks (p < 0.001). Transient superficial radial nerve injury occurred in three patients in the endoscopic group compared with nine in the open release group (p = 0.033). We conclude that endoscopic release for de Quervain's tenosynovitis seems to provide earlier improvement after surgery, with fewer superficial radial nerve complications and greater scar satisfaction, when compared with open release.

Typical and atypical enteropathogenic Escherichia coli bacterial translocation associated with tissue hypoperfusion in rats

Although enteropathogenic Escherichia coli (EPEC) are well-recognized diarrheal agents, their ability to translocate and cause extraintestinal alterations is not known. We investigated whether a typical EPEC (tEPEC) and an atypical EPEC (aEPEC) strain translocate and cause microcirculation injury under conditions of intestinal bacterial overgrowth. Bacterial translocation (BT) was induced in female Wistar-EPM rats (200-250 g) by oroduodenal catheterization and inoculation of 10 mL 10(10) colony forming unit (CFU)/mL, with the bacteria being confined between the duodenum and ileum with ligatures. After 2 h, mesenteric lymph nodes (MLN), liver and spleen were cultured for translocated bacteria and BT-related microcirculation changes were monitored in mesenteric and abdominal organs by intravital microscopy and laser Doppler flow, respectively. tEPEC (N = 11) and aEPEC (N = 11) were recovered from MLN (100 percent), spleen (36.4 and 45.5 percent), and liver (45.5 and 72.7 percent) of the animals, respectively. Recovery of the positive control E. coli R-6 (N = 6) was 100 percent for all compartments. Bacteria were not recovered from extraintestinal sites of controls inoculated with non-pathogenic E. coli strains HB101 (N = 6) and HS (N = 10), or saline. Mesenteric microcirculation injuries were detected with both EPEC strains, but only aEPEC was similar to E. coli R-6 with regard to systemic tissue hypoperfusion. In conclusion, overgrowth of certain aEPEC strains may lead to BT and impairment of the microcirculation in systemic organs.

Effect of pentoxifylline on lung inflammation and gas exchange in a sepsis-induced acute lung injury model.

Experimental models of sepsis-induced pulmonary alterations are important for the study of pathogenesis and for potential intervention therapies. The objective of the present study was to characterize lung dysfunction (low PaO2 and high PaCO2, and increased cellular infiltration, protein extravasation, and malondialdehyde (MDA) production assessed in bronchoalveolar lavage) in a sepsis model consisting of intraperitoneal (ip) injection of Escherichia coli and the protective effects of pentoxifylline (PTX). Male Wistar rats (weighing between 270 and 350 g) were injected ip with 10(7) or 10(9) CFU/100 g body weight or saline and samples were collected 2, 6, 12, and 24 h later (N = 5 each group). PaO2, PaCO2 and pH were measured in blood, and cellular influx, protein extravasation and MDA concentration were measured in bronchoalveolar lavage. In a second set of experiments either PTX or saline was administered 1 h prior to E. coli ip injection (N = 5 each group) and the animals were observed for 6 h. Injection of 10(7) or 10(9) CFU/100 g body weight of E. coli induced acidosis, hypoxemia, and hypercapnia. An increased (P < 0.05) cell influx was observed in bronchoalveolar lavage, with a predominance of neutrophils. Total protein and MDA concentrations were also higher (P < 0.05) in the septic groups compared to control. A higher tumor necrosis factor-alpha (P < 0.05) concentration was also found in these animals. Changes in all parameters were more pronounced with the higher bacterial inoculum. PTX administered prior to sepsis reduced (P < 0.05) most functional alterations. These data show that an E. coli ip inoculum is a good model for the induction of lung dysfunction in sepsis, and suitable for studies of therapeutic interventions.

Effect of pentoxifylline on lung inflammation and gas exchange in a sepsis-induced acute lung injury model

Experimental models of sepsis-induced pulmonary alterations are important for the study of pathogenesis and for potential intervention therapies. The objective of the present study was to characterize lung dysfunction (low PaO2 and high PaCO2, and increased cellular infiltration, protein extravasation, and malondialdehyde (MDA) production assessed in bronchoalveolar lavage) in a sepsis model consisting of intraperitoneal (ip) injection of Escherichia coli and the protective effects of pentoxifylline (PTX). Male Wistar rats (weighing between 270 and 350 g) were injected ip with 10(7) or 10(9) CFU/100 g body weight or saline and samples were collected 2, 6, 12, and 24 h later (N = 5 each group). PaO2, PaCO2 and pH were measured in blood, and cellular influx, protein extravasation and MDA concentration were measured in bronchoalveolar lavage. In a second set of experiments either PTX or saline was administered 1 h prior to E. coli ip injection (N = 5 each group) and the animals were observed for 6 h. Injection of 10(7) or 10(9) CFU/100 g body weight of E. coli induced acidosis, hypoxemia, and hypercapnia. An increased (P < 0.05) cell influx was observed in bronchoalveolar lavage, with a predominance of neutrophils. Total protein and MDA concentrations were also higher (P < 0.05) in the septic groups compared to control. A higher tumor necrosis factor-alpha (P < 0.05) concentration was also found in these animals. Changes in all parameters were more pronounced with the higher bacterial inoculum. PTX administered prior to sepsis reduced (P < 0.05) most functional alterations. These data show that an E. coli ip inoculum is a good model for the induction of lung dysfunction in sepsis, and suitable for studies of therapeutic interventions.

99mTc-MIBI scan in mammary Pagets disease: a case report.

Technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) uptake is known to be increased in breast cancer because of increased blood flow from angiogenesis and heightened metabolism. We performed a 99mTc-MIBI scan in a patient with mammary Paget's disease. The patient had underlying invasive cancer in the same side of the breast. 99mTc-MIBI scan exhibited a scintigraphic image of the uptake from the invasive cancer lesion located deeply in the breast toward the epidermis. 99mTc-MIBI showed an uptake in the deeply located invasive cancer lesion as well as nipple lesion. Especially, the delayed phase of Tc-MIBI scan demonstrated the tumor site more accurately. In conclusion, 99mTc-MIBI scan could be a useful adjunct to clinical decision making in the management of Paget's disease of the breast.

Valor del isómero dextrógiro del ácido láctico sérico en la isquemia intestinal en ratas / Value of serum d-lactate levels during intestinal isquemia in rats

El D-lactato fue estudiado in vitro como marcador de isquemia intestinal asociada a la presencia de bacterias patógenas en el intestino de ratas. En un estudio in vitro se correlacionó la producción de D-lactato con el crecimiento de dos cepas de E coli. En el estudio in vivo se utilizaron 100 ratas Wistar de 250a 300 gr divididos en ausencia y presencia de isquemia intestinal. Los resultados in vitro demostraron que la producción de D-lactato es acumulativa. Los resultados in vivo demostraron que el nivel sérico de D-lactato dependió de la concentración bacteriana intraluminal y no de la gravedad de la isquemia. Cuando ambas variables fueron asociadas, se produjo un efecto sinérgico en la elevación sérica de D-lactato, mayor en comparación a cada variable aislada. Se observaron resultados similares con la flora natural con o sin isquemia intestinal. Basados en los datos obtenidos, los niveles de D-lactato sérico parecen tener un rol potencial como marcador de isquemia intestinal, cuando se agrega la presencia de bacterias en la luz intestinal

The comparative effects of cyclosporin A and 16,16 dimethyl prostaglandin E2 on the allogeneic induction of monocyte/macrophage procoagulant activity and the cytokines macrophage procoagulant inducing factor and interleukin-2.

It has recently been reported that combination immunotherapy utilizing cyclosporin A (CsA) and prostaglandin E (PGE) reduced the frequency of acute renal allograft rejection; however, the mechanism for the benefit of this combination therapy is uncertain. Since our previous studies have suggested that macrophage procoagulant activity (PCA) is an important mediator of allograft rejection, in this study we have examined the effects of CsA and 16,16 dimethyl prostaglandin E2 (dmPGE2) alone and in combination on the induction of macrophage PCA and on the lymphokines macrophage procoagulant-inducing factor (MPIF) and interleukin-2 (IL-2) in vitro. Alloantigen-induced MPIF activity could be detected within 8 hr, reaching maximal levels by 12 hr and could still be detected at 24 hr. Allogeneic induction of PCA in splenic mononuclear cells was detectable by 24 hr, reaching maximal levels at 72 hr and was still detectable after 120 hr. CsA at concentrations from 100 ng/ml to 1000 ng/ml completely inhibited production of MPIF and IL-2, but had minimal effects on the ability of MPIF to induce isolated macrophage to express PCA. In contrast, dmPGE2 (10(-12)-10(-6) M) inhibited both the induction of MPIF and the ability of MPIF directly to induce macrophages to express PCA, with lesser effects on the induction of IL-2. The effects of minimal inhibitory concentrations of CsA and dmPGE2 in combination resulted in synergistic inhibition of PCA induction. These data demonstrate the disparate actions of CsA and dmPGE2 on inhibition of PCA, MPIF and IL-2, and provide a possible mechanism for the beneficial effects of combination CsA and dmPGE2 in patients receiving organ allografts.

Novo caso de angiostrongilose abdominal. / A new case of abdominal angiostrongyliasis

E apresentado o caso de uma crianca do sexo feminino de 5 anos de idade que apresentava uma massa palpavel na fossa iliaca direita.Havia leucocitose com intensa eosinofilia (52%). Levada a cirurgia foi encontrada uma massa nodular na juncao ileo-cecal tendo sido ressecados em bloco o ileo terminal, ceco e apendice. O exame da peca cirurgica mostrava espessamento da parede do ceco com areas de necrose de permeio. Histologicamente havia denso infiltrado eosinofilico por toda a parede com alguns vasos arteriais da serosa e submucosa apresentando em seu lumen seccoes transversais de parasitos identificado como sendo Angiostrongylus costaricensis e outros exibindo trombose intravascular. O presente registro constitui o quinto caso brasileiro de parasitismo por esse angiostrongilideo