Specific cytokine patterns of pulmonary tuberculosis in Central Africa

Different cytokines have been suggested to be involved in the pathogenesis of pulmonary tuberculosis (TB). The frequencies of Mycobacterium tuberculosis (MTB) specific CD4(+) and CD8(+) T cells, CD4(+)CD25(+) Forkhead Box Protein (FoxP)3(+) T cells, interleukin (IL)-6, interferon (IFN)-γ, Tumor necrosis factor (TNF)-α, transforming growth factor (TGF)-β and IL-10 were assessed in HIV-negative, pulmonary tuberculosis (TB) patients (n=30) and in healthy controls (n=23) in Gabon. Peripheral blood mononuclear cells (PBMC) were stimulated with purified protein derivative (PPD) and early secretory antigenic target-6 (ESAT-6). In patients, a pronounced pro-inflammatory cytokine response with highly significant increased levels of IL-6 and TNF-α accompanied by increased TGF-β was detectable. Differences in IFN-γ responses between patients and healthy individuals were less pronounced than expected. FoxP3 expression did not differ between groups. A distinct cytokine pattern is associated with active pulmonary TB in patients from Central Africa.     

Effect of PEEP and jugular venous compression on canine cerebral blood flow and oxygen consumption in the head elevated position

Cerebral blood flow (CBF) (radiolabelled microspheres) and oxygen consumption (CMRO2) were studied in nine dogs during 30 min of either neck vein compression or application of positive end-expiratory pressure (PEEP) ventilation. With the animal in the prone position, elevation of the head from horizontal to 30 cm above the heart markedly decreased cisterna magna (PCSF) and dorsal sagittal sinus pressure (PCV). With the head elevated, compression of neck veins using neck tourniquet (pressure 40 mmHg) increased PCSF and PCV from 3.6 +/- 2.2 to 6.8 +/- 4.8 and -2.5 +/- 2.7 to 2.3 +/- 2.3 mmHg (mean +/- SE, P less than 0.05), respectively, while total or regional CBF and CMRO2 remained unchanged. Application of PEEP (15 cm H2O) increased right atrial pressure (-4.7 +/- 1.7 to -0.1 +/- 3.4 mmHg, P less than 0.05), but did not affect PCSF or PCV (3.4 +/- 3.3 to 3.3 +/- 3.7 and -3.5 +/- 2.6 to -4.1 +/- 2.4 mmHg, respectively, P greater than 0.05). Total or regional CBF and CMRO2 were also unaffected. These data demonstrate that, although neither maneuver affects CBF or CMRO2, neck vein compression elevates PCV above atmospheric pressure, but PEEP does not. In patients at risk for cerebral venous embolism, intermittent neck vein compression should be used as a prophylactic measure to prevent air embolism.     

Repair of nasal defects using collagen gels containing insulin-like growth factor 1

Objective: Facial osseous defects are a common and challenging problem for the otolaryngologist—head and neck surgeon. Current methods of repair including synthetic grafts, cadaveric material, and autologous tissue have drawbacks of foreign body reactions, infectious agent transmission, and the morbidity of a second surgical site. In the effort to develop an ideal technique for osseous reconstruction, a critical-size facial defect has previously been developed in the Sprague-Dawley rat. This model exhibits less than 10% healing by surface area over 6 months. A novel approach to osseous reconstruction is attempted using this model with type I collagen gel augmented with insulin-like growth factor 1 (IGF-1). Study Design: Randomized controlled trial using a rodent model. Methods: Twelve adult male Sprague-Dawley rats underwent a surgical procedure to produce a critical-size nasal defect by removing the nasal bones with a cutting burr. Six animals were repaired with 300 μg of type I collagen gel. Six animals were repaired with 300 μg of type I collagen gel augmented with 3.0 μg of IGF-1. Thirty days later, the animals were examined after necropsy. Precise planimetry, radiodensitometric analysis, and histologic sectioning were performed. Results: All animals had complete coverage of this defect with a thin layer of bone. Radiodensitometric analysis indicated that there was a statistically significant (P < .037) increase in bone density in the collagen plus IGF-1 group compared with that of collagen only. In addition, histologic evaluation revealed increased bone density and thickness in the IGF-1 group. Conclusion: Type I collagen gel augmented with IGF-1 results in a significant increase in healing of a nasal critical-size defect in a rodent model. Laryngoscope, 108:1654–1658, 1998     

Repair of a rodent nasal critical-size osseous defect with osteoblast augmented collagen gel.

OBJECTIVES/HYPOTHESIS: Facial skeletal defects are a common challenge for the otolaryngologist. Type I collagen gels have shown promise in the repair of nonhealing critical size defects (CSDs) of facial bone by providing scaffolding for new bone growth by osteoblasts at the defect perimeter. The objective of the present study was to evaluate the effect that suspending osteoblasts within a type I collagen gel has on the repair of a rodent facial CSD. STUDY DESIGN: Randomized controlled trial using a rodent model. METHODS: A previously described facial CSD was created by removing the nasalis bones with a cutting burr to the level of the nasal mucosal membranes on 18 Sprague-Dawley rats. Groups of six animals were treated with an implant containing either 300 microg of type I collagen gel, 12 x 10(5) osteoblasts suspended within type I collagen gel, or 12 x 10(5) fibroblasts suspended within type I collagen gel for comparison. After 30 days the animals-were examined at necropsy with planimetry, histological analysis of new bone growth, and radiodensitometric analysis of bone thickness. RESULTS: All animals had complete coverage with a thin layer of bone. Histological sectioning revealed an increased thickness in the osteoblast augmented group. Radiodensitometric measurements revealed a statistically significant increase in bone repair in the osteoblast group compared with the collagen-only group (P < or = .0005) and the fibroblast group (P < or = .04). CONCLUSION: Type I collagen gels augmented with an osteoblastic suspension significantly enhance the repair of nasal CSDs in a rodent model. The use of cultured bone precursor cells represents a leap forward in osteoengineering.     

Unilateral sensorineural hearing loss after spine surgery: Case report and review of the literature

BACKGROUND: Sudden sensorineural hearing loss is infrequent, with an estimated incidence of 5 to 20 cases yearly per 100,000 people. Although multiple etiologies have been identified, infection and idiopathic SNHL are most common. Sudden sensorineural hearing loss after nonotologic noncardiac surgery is highly unusual, particularly after spinal surgery. CASE DESCRIPTION: We report a case of unilateral sudden SNHL after lumbar spinal fusion with review of the literature. Potential etiologies, treatment, and prognosis are summarized. CONCLUSION: Multiple etiologies have been proposed for SNHL after nonotologic noncardiac surgery. Excessive positive upper airway pressure during induction of anesthesia or Valsalva maneuvers can result in SNHL from LMR. Aberrant NO accumulation in the middle ear cavity during general anesthesia with subsequent LMR is also a potential etiology, as is excessive leakage of CSF causing a form of endolymphatic hydrops. There is no definitive treatment of postoperative SNHL, although middle ear exploration may be beneficial for suspected overpressure injury to the middle ear, causing a perilymphatic fistula. Corticosteroids have been beneficial in certain cases of idiopathic SNHL; however, its effectiveness for postoperative SNHL is undocumented.     

Measurement of carotid blood flow in man and its clinical application

With the use of a new ultrasonic volume flow meter (VFM), over 8000 measurements of common carotid blood flow were made in 120 normal control subjects and 550 patients with various neurological disease. The accuracy of the flow meter in measuring blood flow on an experimental model ranged from 93 to 97%. In normal subjects, common carotid blood flow varies with age. It increased from newborn to age 20 and gradually decreased thereafter. In normal healthy subjects, the flow varies within +/- 6.7% (2SD) at one sitting (intrasession) and +/- 21.2% (2SD) from week to week (intersession study). Carotid blood flow varies linearly with PaCO2 and increased markedly in response to endotracheal intubation. In healthy adults, the flow ratio between the two common carotid arteries is 1.07 +/- 0.052. This ratio increases in patients with transient ischemic attacks to 1.28 +/- 0.23 (p less than 0.05) and in patients with intracranial space occupying lesions to 1.46 +/- 0.39, (p less than 0.01). In 26 consecutive cases of carotid endarterectomies, the preoperative common carotid blood volume flow was 5.1 +/- 1.0 cc/sec. All cases preoperatively had at least 30% stenosis and ranged from 30 to 100% stenosis. The carotid blood volume was significantly increased post-operatively (p less than 0.001). The overall accuracy in detecting carotid and cerebral arterial disease is 89% with sensitivity of 96% and the specificity of 71%. Our clinical experience indicates that this device is not only a valuable noninvasive diagnostic tool for evaluation of carotid disease but also appears to be useful in assessing cerebral blood flow.