Extradural hematoma: analysis of factors influencing the courses of 161 patients

The clinical and computed tomographic (CT) findings in a series of 161 consecutive patients operated upon for postraumatic extradural hematoma are analyzed. Thirteen (8%) patients had delayed epidural hematoma formation. The overall mortality for the series was 12%, significantly lower than that observed during the prior "angiographic" period at the same unit (30%). Because all but 1 of the deaths occurred among the 66 patients unconscious at the time of operation (27% mortality in this subgroup), the authors sought differential factors between comatose and noncomatose patients at operation. There were no significant differences between these groups in age, sex, mechanism of injury, preoperative course of consciousness (lucid interval or not), or epidural hematoma location and shape. In contrast, significant differences were seen between the two subgroups in trauma-to-operation interval, hematoma volume, CT hematoma density (mixed low-high CT density vs. homogeneous hyperdensity), midline displacement, severity of associated intracranial lesions, and postoperative intracranial pressure (ICP). Patients comatose at operation usually evidenced a more rapid clinical deterioration (a shorter trauma-to-operation interval) and tended to have a large hematoma volume, a higher incidence of mixed CT density clot (hyperacute bleeding), more marked shift of midline structures, more severe associated lesions, and higher postoperative ICP levels.     

Admission stool guaiac test: use and impact on patient management.

PURPOSE: A stool guaiac test is often performed on newly hospitalized patients as part of the admission evaluation. However, little is known regarding the value of testing stool obtained by digital rectal examination. We sought to document the use of the admission stool guaiac test in a teaching hospital, to determine its diagnostic yield, and to assess its potential benefit to patients. MATERIALS AND METHODS: We performed a retrospective review of the medical records for 264 consecutive patients admitted to internal medicine services during a single month, of whom 202 received a stool guaiac test on admission. Information was collected on the frequency of guaiac testing, indications for testing, test results, and diagnoses established. RESULTS: Criteria were established to distinguish "clinically indicated" from "routine" use of the admission stool guaiac test. Indicated tests were positive more often than routinely performed tests (35% versus 11%, p less than 0.001). Most patients with positive tests received further testing for gastrointestinal disease, whether or not the test was indicated. Of 104 patients with indications, 25 were ultimately found to have gastrointestinal lesions, most of which were clinically important. Of 98 patients tested routinely, only four had diagnoses established, of whom three had benign conditions. Four of five patients with cancer had clinical indications for testing. The fifth was diagnosed only after he experienced gross rectal bleeding several days after admission. CONCLUSIONS: Like other commonly applied diagnostic tests, the stool guaiac test obtained during the admission physical examination is best reserved for patients whose clinical presentation provides a reason for testing. In patients without clinical indications, the test is of uncertain value and only infrequently leads to important diagnoses.     

Wheat tetrameric inhibitors of insect alpha-amylases: Alloploid heterosis at the molecular level

Tetrameric inhibitors of heterologous α-amylases have been characterized in allohexaploid wheat, Triticum aestivum (genomes AABBDD), as well as in Triticum turgidum (AABB) and Triticum tauschii (DD). Their subunits have been identified as the previously described CM proteins. Single oligomeric species were observed in T. Turgidum (subunits CM2, CM3A, and CM16) and in T. tauschii (CM1, CM3D, and CM17) by a two-dimensional electrophoretic method that does not dissociate the inhibitors in the first dimension. Multiple tetrameric species, resulting from different combinations of the subunits contributed by the two ancestral species, are observed by the same procedure in T. aestivum. The three types of subunits were required for significant activity when the inhibitor of T. turgidum was reconstituted from the purified subunits, whereas, in the case of T. tauschii, binary mixtures involving subunit CM1 also had some activity. Additional combinations of the subunits present in these two species, which occur in the allohexaploid T. aestivum, were also reconstituted, and their inhibitory activities ranged from 144% to 33% the activity of the reconstituted inhibitor from T. tauschii. The activity of these inhibitors toward the α-amylase (1,4-α-D-glucan glucanohydrolase, EC 3.2.1.1) of the insect Tenebrio molitor is much greater than that against the salivary enzyme. These observations, together with the previously established chromosomal locations of genes encoding CM proteins, fit a model of alloploid heterosis at the molecular level.     

Image-directed percutaneous biopsies with a biopsy gun

Core tissue for histologic study is believed by many pathologists to be more diagnostic than material from needle aspiration. Recently, a biopsy "gun" has been introduced, which simplifies core biopsies. With this device, 182 biopsies of multiple anatomic sites were performed with ultrasonic, computed tomographic, and fluoroscopic guidance and 18-gauge needles. High-quality histopathologic specimens were obtained in 177 of the biopsies, and diagnostic target tissue was obtained in 167. Only three significant complications occurred: one bleeding complication that required transfusion and two cases of pneumothorax that necessitated placement of chest tubes. The biopsy gun eliminated the disjointed movements of conventional "skinny" needle biopsies, and none of the samples demonstrated significant "crush" artifact or obscuring blood, problems that are commonly associated with manual biopsy techniques. Patient discomfort was decreased with this system compared with that of manual biopsies, and the total procedure time was reduced. Because of these distinct advantages, the authors now use the biopsy gun exclusively for all percutaneous biopsies and recommend that other institutions consider the use of this biopsy method.     

新生期大白鼠皮下注射谷氨酸单钠对成年后下丘脑α-促黑素细胞激素神经元免疫反应性的影响

本文用免疫组化方法研究了新生期大白鼠注射谷氨酸单钠(MSG)对成年后下丘脑α-促黑素细胞激素(α-MSH)免疫反应神经元的影响,结果显示MSG处理以后下丘脑弓状核区α-MSII免疫反应神经元减少甚至完全消失,但不影响下丘脑背外侧区的α-MSH神经元群。文中还讨论了这两群α-MSH神经元的生理作用。     

Mannoprotein from Cryptococcus neoformans promotes T-helper type 1 anticandidal responses in mice

We previously demonstrated that mannoprotein (MP) from Cryptococcus neoformans (CnMP) stimulates interleukin-12 production by human monocytes, thus fostering a T-helper type 1 (Th1) protective anticryptococcal response. In this paper we show that CnMP was also able to induce a Candida albicans-directed protective Th1 response. This was demonstrated for mice immunized with CnMP by induction of a delayed-type hypersensitivity (DTH) reaction to C. albicans MP (CaMP) as well as induction of gamma interferon production by CD4(+) and CD8(+) splenic T cells stimulated in vitro with CaMP. CnMP-immunized mice were also partially protected from lethal systemic challenge with C. albicans, as shown by prolonged median survival times and decreased fungal burden in the kidney. Much evidence supports the validity of these cross-reactive and functional Th1 responses: (i) a non-cross-reactive C. albicans antigen, such as enolase, did not produce a DTH response to CaMP; (ii) passive adoptive transfer of T cells primed with CnMP induced a DTH reaction; (iii) C. neoformans extract elicited a DTH response to CaMP; and (iv) a monoclonal antibody (7H6) directed against a major and immunodominant T-cell-stimulatory 65-kDa MP (MP65) of C. albicans also recognized discrete 100-kDa constituents of C. neoformans extracts, as well as secretory constituents of the fungus. These results suggest the presence of common Th1 antigenic determinants in the mannoproteic material of C. neoformans and C. albicans epitopes, which should be considered in devising common strategies for immunoprophylactic or immunotherapeutic control of the fungi.     

Medial nucleus of the amygdala in the adult Syrian hamster: a quantitative Golgi analysis of gonadal hormonal regulation of neuronal morphology.

The medial nucleus of the amygdala (Me) processes both chemosensory and hormonal input. In the male Syrian hamster the integrity of this nucleus is essential for normal reproductive behavior. To determine if gonadal steroids modulate neuronal structure in this nucleus, the morphology of Golgi-stained neurons in the anterior and posterior regions of Me were compared in castrated and reproductively intact adult hamsters. In castrated males, neurons in the posterior, but not the anterior, region of Me undergo structural changes, as indicated by a decrease in the mean highest dendritic branch level and mean somal area compared to intact males. To further elucidate the importance of testosterone and its metabolites in maintenance of neuronal structure in the adult, seven groups of male Syrian hamsters were studied. Animals were castrated and received a blank silastic capsule or a capsule filled with either testosterone, dihydrotestosterone, or estradiol, or two capsules containing both metabolites, dihydrotestosterone and estradiol. Two groups of reproductively intact animals were included: brains from one group were processed simultaneously with the castrated and hormone-treated groups (control intact group), and the other group was processed at the beginning of the experiment. Animals were tested for mating behavior and flank glands were measured to test whether the capsules were effective in releasing the hormones into circulation. After a 12-week survival period, the brains were processed with Golgi stain and well-impregnated neurons from the posterior Me were quantitatively analyzed for somal area, highest dendritic branch, total dendritic length, and density of spines. All the measures analyzed revealed a consistent pattern of response to the different gonadal steroids. Castration resulted in a decrease in the mean somal area, the mean highest dendritic branch, and the percentage of neurons with tertiary branch segments. Dihydrotestosterone treatment also resulted in a significant decrease in somal area, mean highest dendritic branch, and percentage of neurons with tertiary dendritic branches. In addition, the total dendritic length and spine density on terminal dendrites were reduced in these brains. The remaining hormone treatment groups were not significantly different from the control group. These results suggest that in orchidectomized male Syrian hamsters, testosterone or its aromatized form, estradiol, but not dihydrotestosterone, is sufficient to maintain the normal morphology of the neurons in the posterior part of the medial nucleus of the amygdala.     

During active viscerocutaneous leishmaniasis the anti-P2 humoral response is specifically triggered by the parasite P proteins.

In this work we show that in the sera from dogs naturally infected with the protozoan parasite Leishmania infantum there are antibodies that react specifically against the parasite acidic ribosomal proteins LiP2a and LiP2b, and that each one of the Leishmania P proteins elicits a specific humoral immune response. Using synthetic peptides, the antigenic epitope of these proteins has been mapped in a single region located adjacent to the C-terminal domain highly conserved among the eukaryotic P proteins. The anti-P antibodies elicited during the Leishmania infection do not recognize the conserved C-terminal domain of the parasite P proteins, in contrast with the findings reported in Chagas' disease or systemic lupus erythematosus. The antigenic epitopes of the LiP2a and LiP2b are almost identical in amino acid sequence. No reactivity against Trypanosoma cruzi and human P proteins was found in sera from L. infantum-infected dogs.     

Cytokine gene expression in human peripheral blood mononuclear cells stimulated by mannoprotein constituents from Candida albicans.

The expression of cytokine genes in cultures of human peripheral blood mononuclear cells (PBMC) stimulated with mannoprotein constituents (MP) of Candida albicans has been studied by means of S1 nuclease mapping analysis, polymerase chain reaction, and enzyme-linked immunosorbent assay. MP induced early, consistent, and long-lasting production of interleukin-1 beta (IL-1 beta), tumor necrosis factor alpha, and IL-6 mRNAs. Similar results were obtained when the same PBMC cultures were stimulated with the purified protein derivative (PPD) from Mycobacterium tuberculosis or with IL-2, although lower levels of IL-6 mRNA were detected in IL-2-stimulated cells than in MP- or PPD-stimulated cells. MP, PPD, and IL-2 induced appreciable levels of granulocyte-macrophage colony-stimulating factor and gamma interferon, but only MP and PPD were able to induce IL-2 mRNA. MP were unable to stimulate a consistent expression of the genes encoding for IL-4, IL-5, and IL-10, while low, sometimes barely detectable levels of these cytokine mRNAs were observed in PPD- or IL-2-stimulated PBMC cultures. When protein synthesis of MP-stimulated PBMC was inhibited by cycloheximide, a superinduction of mRNAs for IL-4 and IL-10 and, more markedly, gamma interferon was observed. Overall, these results highlight the powerful, selective induction of cytokine gene expression by MP constituents of C. albicans in human PBMC cultures, thus providing some functional clues to explain the efficient state of the anticandidal response in normal human subjects.