The nitric oxide-cyclic guanosine monophosphate pathway inhibits the bladder ATP release in response to a physiological or pathological stimulus.

The release of ATP from the epithelium of the urinary bladder (urothelium) in response to mechanical/chemical stimuli contributes to the visceral sensation in the micturition reflex. The nitric oxide (NO)-mediated induction of cyclic guanosine monophosphate (cGMP) has been detected in urothelial cells and may inhibit the micturition reflex. However, the function of the NO-cGMP pathway in the regulation of urothelial ATP release remains poorly understood in contrast to its effects on smooth muscles or primary afferent nerves. Therefore, we investigated the relevance of the NO-cGMP pathway to ATP release on the mucosal side in the present study. The administration of l-arginine (NO precursor) or NOC 12 (NO donor) significantly reduced ATP release to the mucosal side at a physiologically normal urine storage pressure (5 cmH2 O). L-NAME (NO synthase inhibitor) significantly increased the distention-induced release of ATP. The phosphodiesterase-5 inhibitor, sildenafil, which increases cGMP levels, inhibited distention-induced ATP release. Furthermore, sildenafil significantly reduced ATP release in response to the administration of lipopolysaccharide. These results suggest that the NO-cGMP pathway inhibited urothelial ATP release during the storage phase under both physiological and pathological conditions.

Increased Hydrostatic Pressure Promotes Primary M1 Reaction and Secondary M2 Polarization in Macrophages.

Patients with chronic anterior uveitis are at particularly high risk of developing secondary glaucoma when corticosteroids [e.g., dexamethasone (Dex)] are used or when inflammatory activity has regressed. Macrophage migration into the eye increases when secondary glaucoma develops and may play an important role in the development of secondary glaucoma. Our aim was to evaluate in vitro if increased hydrostatic pressure and corticosteroids could induce changes in macrophages phenotype. By using a pressure chamber cell culture system, we assessed the effect of increased hydrostatic pressure (HP), inflammation, and immunosuppression (Dex) on the M1/M2 phenotype of macrophages. Bone marrow-derived macrophages (BMDMs) were stimulated with medium, lipopolysaccharide (LPS, 100 ng/ml), Dex (200 ng/ml), or LPS + Dex and incubated with different HP (0, 20, or 60 mmHg) for 2 or 7 days. The numbers of CD86+/CD206- (M1 phenotype), CD86-/CD206+ (M2 phenotype), CD86+/CD206+ (intermediate phenotype), F4/80+/TNF-α+, and F4/80+/IL-10+ macrophages were determined by flow cytometry. TNF-α and IL-10 levels in cell culture supernatants were quantified by ELISA. TNF-α, IL-10, fibronectin, and collagen IV expression in BMDMs were detected by immunofluorescence microscopy. Higher HP polarizes macrophages primarily to an M1 phenotype (LPS, 60 vs. 0 mmHg, d2: p = 0.0034) with less extra cellular matrix (ECM) production and secondary to an M2 phenotype (medium, 60 vs. 0 mmHg, d7: p = 0.0089) (medium, 60 vs. 20 mmHg, d7: p = 0.0433) with enhanced ECM production. Dex induces an M2 phenotype (Dex, medium vs. Dex, d2: p < 0.0001; d7: p < 0.0001) with more ECM production. Higher HP further increased M2 polarization of Dex-treated macrophages (Dex, 60 vs. 0 mmHg, d2: p = 0.0417; d7: p = 0.0454). These changes in the M1/M2 phenotype by high HP or Dex treatment may play a role in the pathogenesis of secondary uveitic glaucoma- or glucocorticoid (GC)-induced glaucoma.

High hydrostatic pressure induces atrial electrical remodeling through upregulation of inflammatory cytokines.

AIMS: Hypertension is an independent risk factor for atrial fibrillation (AF). However, the direct effect of hydrostatic pressure on atrial electrical remodeling is unclear. The present study investigated whether hydrostatic pressure is responsible for atrial electrical remodeling and addressed a potential role of inflammation in this pathology. MAIN METHODS: Whole-cell patch-clamp recordings and biochemical assays were used to study the regulation and expression of ion channels in left atrial appendages in patients with AF, spontaneously hypertensive rats (SHRs), and atrium-derived cells (HL-1 cells) exposed to standard (0 mmHg) and elevated (20, 40 mmHg) hydrostatic pressure. KEY FINDINGS: Both TNF-α and MIF were highly expressed in patients with AF and SHRs. AF inducibility in SHRs was higher after atrial burst pacing, accompanied by a decrease in the L-type calcium current (ICa,L), an increase in the transient outward K+ current (Ito) and ultra-rapid delayed rectifier K+ current (IKur), and a shortened action potential duration (APD), which could be inhibited by atorvastatin. Furthermore, exposure to elevated pressure was associated with electrical remodeling of the HL-1 cells. The peak current density of ICa,L was reduced, while Ito and IKur were increased. Moreover, the expression levels of Kv4.3, Kv1.5, TNF-α, and MIF were upregulated, while the expression of Cav1.2 was downregulated in HL-1 cells after treatment with high hydrostatic pressure (40 mmHg). Atorvastatin alleviated the electrical remodeling and increased inflammatory markers in HL-1 cells induced by high hydrostatic pressure. SIGNIFICANCE: Elevated hydrostatic pressure led to atrial electrical remodeling and increased AF susceptibility by upregulating inflammation.

Management of industrial high-pressure fluid injection injuries (IHPFII): the Water Jetting Association (WJA) experience with water driven injuries.

BACKGROUND: Industrial high-pressure fluid injection injuries (IHPFII) are largely occupational in nature, where these injuries are most often sustained by male manual workers. Such traumatic injuries are largely sustained with water, grease, paint, gasoline or paint thinner. IHPFII are extremely serious injuries with life and limb-threatening potential carrying the risk of life-long disability. METHODS: We reviewed the Water Jetting Association© adverse incident database of advisory alerts detailing cases from around the world that have been brought to the association's attention and the English-language literature on high-pressure hydrostatic injuries from 1937 to 2018. RESULTS: Accidents involving high-pressure water jets in the industry are uncommon. The clinical impact in all of the cases reviewed and the effects of water jet impacts range from instant fatalities at scene to loss of limb function and amputation. The majority of observed fatalities are due to major hemorrhage (exsanguination) secondary to the direct dissection of great vessels or high-energy blunt soft tissue injury and traumatic brain injury. CONCLUSIONS: As with any other trauma, IHPWJI commonly result in amputation or death. Nonetheless, a lack of comprehension of the potential severity of injuries and range of infective complications appears to be largely due to the apparent benignity of the initial presentation of the wound. This in turn leads to delays (both avoidable and unavoidable) in the transfer to appropriate medical facilities and definitive care. There is an identifiable need for education (including for health care providers across multiple levels), training and the availability of personal trauma kits for the timely and effective management of IHPWJI from the initial jet impact on the scene, as well as a need for an established referral system.

Hydrostatic pressure-generated reactive oxygen species induce osteoarthritic conditions in cartilage pellet cultures.

Osteoarthritis (OA) is one of the most common causes of disability and represents a major socio-economic burden. Despite intensive research, the molecular mechanisms responsible for the initiation and progression of OA remain inconclusive. In recent years experimental findings revealed elevated levels of reactive oxygen species (ROS) as a major factor contributing to the onset and progression of OA. Hence, we designed a hydrostatic pressure bioreactor system that is capable of stimulating cartilage cell cultures with elevated ROS levels. Increased ROS levels in the media did not only lead to an inhibition of glycosaminoglycans and collagen II formation but also to a reduction of already formed glycosaminoglycans and collagen II in chondrogenic mesenchymal stem cell pellet cultures. These effects were associated with the elevated activity of matrix metalloproteinases as well as the increased expression of several inflammatory cytokines. ROS activated different signaling pathways including PI3K/Akt and MAPK/ERK which are known to be involved in OA initiation and progression. Utilizing the presented bioreactor system, an OA in vitro model based on the generation of ROS was developed that enables the further investigation of ROS effects on cartilage degradation but can also be used as a versatile tool for anti-oxidative drug testing.

Diagnosing and managing common genital emergencies in pediatric girls.

The presentation of genital injuries and emergencies in pediatric girls can sometimes be misleading. A traumatic injury with excessive bleeding may be a straddle injury that requires only conservative management, while a penetrating injury may have no recognizable signs or symptoms but require extensive surgery. This issue reviews the most common traumatic genital injuries in girls presenting to the emergency department, including straddle injuries, hematomas, and impalement injuries. Nontraumatic emergencies, including hematocolpos and urethral prolapse, are also discussed. Evidence-based recommendations are presented for identifying and managing these common genital injuries and emergencies in pediatric girls.

A Case of a Ruptured Eyeball Caused by High-Pressure Water Jets.

To report the case of a ruptured eyeball caused by high-pressure water jets. In this study, the right eye of a 49-year-old male was injured by high-pressure water jets while he was engaged in demolition work. Upon examination, remarkable hyphema and vitreous hemorrhage were observed in the injured eye. After treating the patient's right eye with vitrectomy, in addition to lens subluxation and iridodialysis, retinal detachment was observed at the nasal inferior. The edge of the retinal break was found to be incarcerated into the nasal sclera rupture wounds. The findings of this study indicate that direct exposure to high-pressure water jets can cause a rupture of the eyeball. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:451-455.].

Piezo1 is a mechanically activated ion channel and mediates pressure induced pancreatitis.

Merely touching the pancreas can lead to premature zymogen activation and pancreatitis but the mechanism is not completely understood. Here we demonstrate that pancreatic acinar cells express the mechanoreceptor Piezo1 and application of pressure within the gland produces pancreatitis. To determine if this effect is through Piezo1 activation, we induce pancreatitis by intrapancreatic duct instillation of the Piezo1 agonist Yoda1. Pancreatitis induced by pressure within the gland is prevented by a Piezo1 antagonist. In pancreatic acinar cells, Yoda1 stimulates calcium influx and induces calcium-dependent pancreatic injury. Finally, selective acinar cell-specific genetic deletion of Piezo1 protects mice against pressure-induced pancreatitis. Thus, activation of Piezo1 in pancreatic acinar cells is a mechanism for pancreatitis and may explain why pancreatitis develops following pressure on the gland as in abdominal trauma, pancreatic duct obstruction, pancreatography, or pancreatic surgery. Piezo1 blockade may prevent pancreatitis when manipulation of the gland is anticipated.

Effect of high-hydrostatic pressure and moderate-intensity pulsed electric field on plum.

Moderate intensity pulse electric fields were applied in plum with the aim to increase bioactive compounds content of the fruit, while high-hydrostatic pressure was applied to preserve the purées. High-hydrostatic pressure treatment was compared with an equivalent thermal treatment. The addition of ascorbic acid during purée manufacture was also evaluated. The main objective of this study was to assess the effects on microorganisms, polyphenoloxidase, color and bioactive compounds of high-hydrostatic pressure, or thermal-processed plum purées made of moderate intensity pulse electric field-treated or no-moderate intensity pulse electric field-treated plums, after processing during storage. The application of moderate intensity pulse electric field to plums slightly increased the levels of anthocyanins and the antioxidant activity of purées. The application of Hydrostatic-high pressure (HHP) increased the levels of bioactive compounds in purées, while the thermal treatment preserved better the color during storage. The addition of ascorbic acid during the manufacture of plum purée was an important factor for the final quality of purées. The color and the bioactive compounds content were better preserved in purées with ascorbic acid. The no inactivation of polyphenoloxidase enzyme with treatments applied in this study affected the stability purées. Probably more intense treatments conditions (high-hydrostatic pressure and thermal treatment) would be necessary to reach better quality and shelf life during storage.

Piezo type mechanosensitive ion channel component 1 functions as a regulator of the cell fate determination of mesenchymal stem cells.

The extracellular environment regulates the dynamic behaviors of cells. However, the effects of hydrostatic pressure (HP) on cell fate determination of mesenchymal stem cells (MSCs) are not clearly understood. Here, we established a cell culture chamber to control HP. Using this system, we found that the promotion of osteogenic differentiation by HP is depend on bone morphogenetic protein 2 (BMP2) expression regulated by Piezo type mechanosensitive ion channel component 1 (PIEZO1) in MSCs. The PIEZO1 was expressed and induced after HP loading in primary MSCs and MSC lines, UE7T-13 and SDP11. HP and Yoda1, an activator of PIEZO1, promoted BMP2 expression and osteoblast differentiation, whereas inhibits adipocyte differentiation. Conversely, PIEZO1 inhibition reduced osteoblast differentiation and BMP2 expression. Furthermore, Blocking of BMP2 function by noggin inhibits HP induced osteogenic maker genes expression. In addition, in an in vivo model of medaka with HP loading, HP promoted caudal fin ray development whereas inhibition of piezo1 using GsMTx4 suppressed its development. Thus, our results suggested that PIEZO1 is responsible for HP and could functions as a factor for cell fate determination of MSCs by regulating BMP2 expression.

Response of Renal Podocytes to Excessive Hydrostatic Pressure: a Pathophysiologic Cascade in a Malignant Hypertension Model.

BACKGROUND/AIMS: Renal injuries induced by increased intra-glomerular pressure coincide with podocyte detachment from the glomerular basement membrane (GBM). In previous studies, it was demonstrated that mesangial cells have a crucial role in the pathogenesis of malignant hypertension. However, the exact pathophysiological cascade responsible for podocyte detachment and its relationship with mesangial cells has not been fully elucidated yet and this was the aim of the current study. METHODS: Rat renal mesangial or podocytes were exposed to high hydrostatic pressure in an in-vitro model of malignant hypertension. The resulted effects on podocyte detachment, apoptosis and expression of podocin and integrinß1 in addition to Angiotensin-II and TGF-ß1 generation were evaluated. To simulate the paracrine effect podocytes were placed in mesangial cell media pre-exposed to pressure, or in media enriched with Angiotensin-II, TGF-ß1 or receptor blockers. RESULTS: High pressure resulted in increased Angiotensin-II levels in mesangial and podocyte cells. Angiotensin-II via the AT1 receptors reduced podocin expression and integrinß1, culminating in detachment of both viable and apoptotic podocytes. Mesangial cells exposed to pressure had a greater increase in Angiotensin-II than pressure-exposed podocytes. The massively increased concentration of Angiotensin-II by mesangial cells, together with increased TGF-ß1 production, resulted in increased apoptosis and detachment of non-viable apoptotic podocytes. Unlike the direct effect of pressure on podocytes, the mesangial mediated effects were not related to changes in adhesion proteins expression. CONCLUSIONS: Hypertension induces podocyte detachment by autocrine and paracrine effects. In a direct response to pressure, podocytes increase Angiotensin-II levels. This leads, via AT1 receptors, to structural changes in adhesion proteins, culminating in viable podocyte detachment. Paracrine effects of hypertension, mediated by mesangial cells, lead to higher levels of both Angiotensin-II and TGF-ß1, culminating in apoptosis and detachment of non-viable podocytes.

Nonthermal physical technologies to decontaminate and extend the shelf-life of fruits and vegetables: Trends aiming at quality and safety.

Minimally processed fruits and vegetables are one of the major growing sectors in food industry. This growing demand for healthy and convenient foods with fresh-like properties is accompanied by concerns surrounding efficacy of the available sanitizing methods to appropriately deal with food-borne diseases. In fact, chemical sanitizers do not provide an efficient microbial reduction, besides being perceived negatively by the consumers, dangerous for human health, and harmful to the environment, and the conventional thermal treatments may negatively affect physical, nutritional, or bioactive properties of these perishable foods. For these reasons, the industry is investigating alternative nonthermal physical technologies, namely innovative packaging systems, ionizing and ultraviolet radiation, pulsed light, high-power ultrasound, cold plasma, high hydrostatic pressure, and dense phase carbon dioxide, as well as possible combinations between them or with other preservation factors (hurdles). This review discusses the potential of these novel or emerging technologies for decontamination and shelf-life extension of fresh and minimally processed fruits and vegetables. Advantages, limitations, and challenges related to its use in this sector are also highlighted.

Involvement of the MAPK pathway in the pressure-induced synovial metaplasia procedure for the temporomandibular joint.

Abnormal pressure is an important factor that contributes to bone adaptation in the temporomandibular joint (TMJ). We determined the effect of the mitogen-activated protein kinases (MAPK) pathway on the pressure-induced synovial metaplasia procedure for the TMJ, both in vitro and in vivo. Synovial fibroblasts (SFs) were exacted from rat TMJs and exposed to different hydrostatic pressures. The protein extracts were analyzed to determine the activation of ERK1/2, JNK, and p38. Surgical anterior disc displacement (ADD) was also performed on Japanese rabbits, and the proteins of TMJ were isolated to analyze pressure-induced MAPK activation after 1, 2, 4, and 8 weeks. The results showed that the activation of ERK1/2 and JNK in SFs significantly changed with increasing hydrostatic pressure, whereas p38 activation did not change. Moreover, p38 was activated in animals 1 week after surgical ADD. The levels of p38 gradually increased after 2 and 4 weeks, and then slightly decreased but remained higher than in the control 8 weeks after surgical ADD. Nevertheless, JNK was rarely activated after the ADD treatment. Our findings suggest the involvement of MAPK activation in the pressure-induced synovial metaplasia procedure with pressure loading in TMJ.

Human mesenchymal stem cell responses to hydrostatic pressure and shear stress.

The effects of mechanical stimuli to which cells are exposed in vivo are, at best, incompletely understood; in this respect, gene-level information regarding cell functions which are pertinent to new tissue formation is of special interest and importance in applications such as tissue engineering and tissue regeneration. Motivated by this need, the present study investigated the early responses of human mesenchymal stem cells (hMSCs) to intermittent shear stress (ISS) and to cyclic hydrostatic pressure (CHP) simulating some aspects of the biological milieu in which these cells exist in vivo. Production of nitric oxide (NO) and mRNA expression of several known mechanosensitive genes as well as ERK1/2 activation in the hMSC response to the two mechanical stimuli tested were monitored and compared. NO production depended on the type of the mechanical stimulus to which the hMSCs were exposed and was significantly higher after exposure to ISS than to CHP. At the conditions of NO peak release (i.e., at 0.7 Pa for ISS and 50,000 Pa for CHP), ISS was more effective than CHP in up-regulating mechanosensitive genes. ERK1/2 was activated by ISS but not by CHP. The present study is the first to report that PGTS2, IER3, EGR1, IGF1, IGFBP1, ITGB1, VEGFA and FGF2 are involved in the response of hMSCs to ISS. These findings establish that, of the two mechanical stimuli tested, ISS is more effective than CHP in triggering expression of genes from hMSCs which are bioactive and pertinent to several cell functions (such as cell differentiation and release of specific growth factors and cytokines) and also to tissue-related processes such as wound healing.

Effects of Hydrostatic Pressure on Carcinogenic Properties of Epithelia.

The relationship between chronic inflammation and cancer is well known. The inflammation increases the permeability of blood vessels and consequently elevates pressure in the interstitial tissues. However, there have been only a few reports on the effects of hydrostatic pressure on cultured cells, and the relationship between elevated hydrostatic pressure and cell properties related to malignant tumors is less well understood. Therefore, we investigated the effects of hydrostatic pressure on the cultured epithelial cells seeded on permeable filters. Surprisingly, hydrostatic pressure from basal to apical side induced epithelial stratification in Madin-Darby canine kidney (MDCK) I and Caco-2 cells, and cavities with microvilli and tight junctions around their surfaces were formed within the multi-layered epithelia. The hydrostatic pressure gradient also promoted cell proliferation, suppressed cell apoptosis, and increased transepithelial ion permeability. The inhibition of protein kinase A (PKA) promoted epithelial stratification by the hydrostatic pressure whereas the activation of PKA led to suppressed epithelial stratification. These results indicate the role of the hydrostatic pressure gradient in the regulation of various epithelial cell functions. The findings in this study may provide clues for the development of a novel strategy for the treatment of the carcinoma.

Adenosine A2AR blockade prevents neuroinflammation-induced death of retinal ganglion cells caused by elevated pressure.

BACKGROUND: Elevated intraocular pressure (IOP) is a major risk factor for glaucoma, a degenerative disease characterized by the loss of retinal ganglion cells (RGCs). There is clinical and experimental evidence that neuroinflammation is involved in the pathogenesis of glaucoma. Since the blockade of adenosine A2A receptor (A2AR) confers robust neuroprotection and controls microglia reactivity in the brain, we now investigated the ability of A2AR blockade to control the reactivity of microglia and neuroinflammation as well as RGC loss in retinal organotypic cultures exposed to elevated hydrostatic pressure (EHP) or lipopolysaccharide (LPS). METHODS: Retinal organotypic cultures were either incubated with LPS (3 µg/mL), to elicit a pro-inflammatory response, or exposed to EHP (+70 mmHg), to mimic increased IOP, for 4 or 24 h, in the presence or absence of the A2AR antagonist SCH 58261 (50 nM). A2AR expression, microglial reactivity and neuroinflammatory response were evaluated by immunohistochemistry, quantitative PCR (qPCR) and enzyme-linked immunosorbent assay (ELISA). RGC loss was assessed by immunohistochemistry. In order to investigate the contribution of pro-inflammatory mediators to RGC loss, the organotypic retinal cultures were incubated with rabbit anti-tumour necrosis factor (TNF) (2 µg/mL) and goat anti-interleukin-1ß (IL-1ß) (1 µg/mL) antibodies. RESULTS: We report that the A2AR antagonist (SCH 58261) prevented microglia reactivity, increase in pro-inflammatory mediators as well as RGC loss upon exposure to either LPS or EHP. Additionally, neutralization of TNF and IL-1ß prevented RGC loss induced by LPS or EHP. CONCLUSIONS: This work demonstrates that A2AR blockade confers neuroprotection to RGCs by controlling microglia-mediated retinal neuroinflammation and prompts the hypothesis that A2AR antagonists may be a novel therapeutic option to manage glaucomatous disorders.

Effects of dry brining, liquid smoking and high-pressure treatment on the physical properties of aquacultured King salmon (Oncorhynchus tshawytscha) during refrigerated storage.

BACKGROUND: Aquacultured King salmon (Oncorhynchus tshawytscha) pieces were dry brined with a salt/brown sugar mix, dipped in liquid smoke for 3 min, vacuum packed, high hydrostatic pressure (HHP) treated at 600 or 200 MPa for 5 min and stored at 4 °C for up to 40 days. RESULTS: The surface redness (average a*) of the samples increased after dry brining, then decreased after liquid smoke treatment. HHP did not change the outside color of liquid-smoked samples. However, the inside color changed depending on pressure. HHP-treated control samples without dry brining and liquid smoking changed to a pale pink color. HHP at 600 MPa resulted in a significant increase in hardness. Compared with fresh samples, dry-brined samples had reduced water activity, while samples dipped in liquid smoke had lower pH values. CONCLUSION: Dry brining and liquid smoking protect the outside color of salmon against changes caused by HHP. The increase in hardness may counteract the softening of the smoked salmon tissue over time.

Performance of fixed-pressure valve with antisiphon device SPHERA(®) in hydrocephalus treatment and overdrainage prevention.

Patients with hydrocephalus and risk factors for overdrainage may be submitted to ventricular shunt (VS) implant with antisiphon device. The objective of this study was to prospectively evaluate for two years the clinical and tomographic results of the implant of fixed-pressure valves with antisiphon device SPHERA(®) in 35 adult patients, with hydrocephalus and risk factors for overdrainage. Of these, 3 had congenital hydrocephalus in adult patients with very dilated ventricles (Evans index >50%), 3 had symptomatic overdrainage after previous VS implant (subdural hematoma, hygroma or slit ventricle syndrome), 1 had previous chronic subdural hematoma, 15 had normal pressure hydrocephalus with final lumbar pressure <5 cm H(2)O after tap test (40 mL), 6 had pseudotumor cerebri, and 7 had hydrocephalus due to other causes. Clinical improvement was observed and sustained in 94.3% of the patients during the two-year period with no computed tomography (CT) evidence of hypo or overdrainage, and no immediate early or late significant complications.

Performance of fixed-pressure valve with antisiphon device SPHERA® in hydrocephalus treatment and overdrainage prevention / Desempenho da válvula de pressão fixa com antissifão SPHERA® no tratamento da hidrocefalia e na prevenção da ocorrência de hiperdrenagem

Patients with hydrocephalus and risk factors for overdrainage may be submitted to ventricular shunt (VS) implant with antisiphon device. The objective of this study was to prospectively evaluate for two years the clinical and tomographic results of the implant of fixed-pressure valves with antisiphon device SPHERA® in 35 adult patients, with hydrocephalus and risk factors for overdrainage. Of these, 3 had congenital hydrocephalus in adult patients with very dilated ventricles (Evans index >50%), 3 had symptomatic overdrainage after previous VS implant (subdural hematoma, hygroma or slit ventricle syndrome), 1 had previous chronic subdural hematoma, 15 had normal pressure hydrocephalus with final lumbar pressure <5 cm H2O after tap test (40 mL), 6 had pseudotumor cerebri, and 7 had hydrocephalus due to other causes. Clinical improvement was observed and sustained in 94.3% of the patients during the two-year period with no computed tomography (CT) evidence of hypo or overdrainage, and no immediate early or late significant complications.

Pacientes com hidrocefalia e fatores de risco para hiperdrenagem podem ser submetidos ao implante de derivação ventricular (VS) com mecanismo antissifão. O objetivo deste trabalho foi avaliar prospectivamente os resultados clínicos e tomográficos do implante de válvulas de pressão fixa com antissifão SPHERA® em 35 pacientes adultos, com hidrocefalia e risco de hiperdrenagem, acompanhados por dois anos. Destes, 3 apresentavam hidrocefalia congênita em adulto, com ventrículos muito dilatados (índice de Evans >50%); 3 tinham hiperdrenagem sintomática pós-derivação ventricular prévia (hematoma subdural, higroma ou síndrome dos ventrículos colabados; 1 apresentava hematoma subdural crônico pregresso; 15 apresentavam hidrocefalia de pressão normal com pressão lombar final <5 cm H2O após tap test (40 mL); 6 apresentavam pseudotumor cerebral; e 7, devido a outras causas. A melhoria clínica foi detectada e sustentada em 94,3% dos pacientes no período de dois anos, sem indícios tomográficos de hipo ou hiperdrenagem e sem complicações significativas imediatas, precoces ou tardias.

Hydrostatic rectosigmoid perforation: a rare personal watercraft injury.

Personal watercrafts (PWC), also known as jet skis, seadoos, and wave-runners have risen in popularity since their introduction in the 1970s. Hydrostatic rectal injury is a rare presentation of passengers thrown off a PWC. The perforation of the rectum is owing to the excessive hydrostatic force of water exerted through the anal canal. We present the first case of rectosigmoid perforation secondary to PWC hydrostatic injury in Canada. A 14-year-old female passenger presented to the pediatric trauma center with severe abdominal pain and blood per rectum following a fall off the back of a PWC at a local lake. Computed tomography of the abdomen and pelvis demonstrated a laceration in the anterolateral rectal wall at the rectosigmoid junction with associated free intra-peritoneal air and profuse free fluid. At exploratory laparotomy, a full thickness perforation was identified at the rectosigmoid junction. The rectum was oversewn as a Hartman pouch, and a proximal end colostomy was performed to divert the fecal stream. Management of traumatic pediatric rectal injuries involves detailed perineal examination with proctoscopy, and if warranted, exploratory laparotomy. Despite the rare occurrence of hydrostatic rectal perforations in Canada, it is a serious and potentially devastating injury. In the United States, the National Transportation Safety Board recommends wet suit bottoms for all pediatric PWC operators and passengers. In Canada, similar recommendations have not been made. The use of PWC in Canada is less common than in the US. However, it is steadily increasing, especially on local lakes. Education regarding potential injuries and prevention is recommended.