Intermittent systemic exposure to lipopolysaccharide-induced inflammation disrupts hippocampal long-term potentiation and impairs cognition in aging male mice.

Age-related cognitive decline, a common component of the brain aging process, is associated with significant impairment in daily functioning and quality of life among geriatric adults. While the complexity of mechanisms underlying cognitive aging are still being elucidated, microbial exposure and the multifactorial inflammatory cascades associated with systemic infections are emerging as potential drivers of neurological senescence. The negative cognitive and neurobiological consequences of a single pathogen-associated inflammatory experience, such as that modeled through treatment with lipopolysaccharide (LPS), are well documented. Yet, the brain aging impacts of repeated, intermittent inflammatory challenges are less well studied. To extend the emerging literature assessing the impact of infection burden on cognitive function among normally aging mice, here, we repeatedly exposed adult mice to intermittent LPS challenges during the aging period. Male 10-month-old C57BL6 mice were systemically administered escalating doses of LPS once every two weeks for 2.5 months. We evaluated cognitive consequences using the non-spatial step-through inhibitory avoidance task, and both spatial working and reference memory versions of the Morris water maze. We also probed several potential mechanisms, including cortical and hippocampal cytokine/chemokine gene expression, as well as hippocampal neuronal function via extracellular field potential recordings. Though there was limited evidence for an ongoing inflammatory state in cortex and hippocampus, we observed impaired learning and memory and a disruption of hippocampal long-term potentiation. These data suggest that a history of intermittent exposure to LPS-induced inflammation is associated with subtle but significantly impaired cognition among normally aging mice. The broader impact of these findings may have important implications for standard of care involving infections in aging individuals or populations at-risk for dementia.

The management of neonatal posterolateral diaphragmatic hernia.

Between March, 1978, and August, 1980, 7 neonates with a left posterolateral diaphragmatic hernia were seen in respiratory distress within 12 hours of birth. Each had severe acidosis and hypoxia. They were immediately intubated and ventilated. Arterial and central venous lines were inserted, the acidosis was partially corrected, and a dopamine infusion of 5 microgram/kg/min was begun immediately. Continuous monitoring of arterial and venous pressures, core, and skin temperatures, blood gases, and pH was instituted. Diaphragmatic defects were repaired by direct suture in 5 neonates and by Gore-Tex patches in the other 2. The left lung in all patients was hypoplastic. Ventilation and inotropic support were continued for 4 to 5 days post-operatively, and close control of acid-base balance was maintained. All the patients are doing well. We consider the key to survival to be management of the dangerous combination of acidosis (by enhancing peripheral and renal perfusion with dopamine) and hypoxia (by prolonged assisted ventilation).

Inpatient treatment of prolapsing piles: cryosurgery versus Milligan-Morgan haemorrhoidectomy.

A comparative retrospective study, based on clinical assessment and questionnaire analysis, of 97 patients treated by cryosurgical haemorrhoidectomy and 99 patients treated by Milligan-Morgan haemorrhoidectomy, at 4-year average follow-up, has shown that 70 per cent of patients in each group derived complete and lasting relief from their symptoms. Two patients in each group required further treatment. There was no significant difference between the numbers who remembered severe, moderate or mild pain, or in its duration, although fewer cryosurgical patients required opiates. Postoperative discharge ceased in 70 per cent of patients within 2 weeks. When skin tags remained, they were usually inconsequential. Anal stenosis following cryohaemorrhoidectomy did not occur, and has not been reported. Cryohaemorrhoidectomy gave results equal to Milligan-Morgan haemorrhoidectomy in patients with prolapsing piles, with fewer complications, and has the economic advantages of less time in hospital (P less than 0.01) and less time off work (P less than 0.01).

An unusual flexor of the fifth finger.

An unusual digastric flexor muscle of the 5th finger is described arising from the medial epicondyle of the right humerus and being inserted into the proximal phalanx of the 5th finger. Also observed was the absence of flexor digiti minimi and the unusual smallness of the tendon of flexor digitorum superficialis of this finger.

The diagnosis of acute gallbladder disease by technetium-99m-labelled HIDA hepatobiliary scanning.

A series of 105 patients with upper abdominal pain suggestive of biliary colic who had hepatobiliary scans within 48 h of admission to hospital is presented. Fifty of the 65 patients with abnormal scans had operative treatment and gallbladder pathology was found in every case. Fourteen of these patients had hepatobiliary scans which also showed delayed excretion of tracer into the duodenum, and of these, 12 were found to have common bile duct stones and one a stricture of the distal end of the common bile duct. Of the 40 patients who had normal scans, 7 were found to have gallstones on further investigation. In these patients abnormal hepatobiliary scans have shown a 100 per cent correlation with gallbladder disease. We suggest that this is the investigation of choice for the surgeon contemplating early cholecystectomy on patients with suspected acute gallbladder disease.