Corticosteroids and the Generalized Shwartzman Reaction: Mechanisms of Sensitization in the Rabbit

An analysis of the effects of adrenal cortical steroids on the response of the vascular system to bacterial endotoxin has shown that glucocorticoids (cortisone, triamcinolone) are capable of preparing the system for the generalized Shwartzman reaction. On the other hand, the mineralocorticoid desoxycorticosterone acetate does not have this capability. The mechanism of preparation by glucocorticoids has been studied. Administering insulin, with maintenance of normal blood sugar, had no effect on the extent of glomerular capillary thrombosis. Blockade, however, of α-adrenergic receptor sites by Dibenzyline caused a significant reduction of the thrombosis. In addition, cortisone-treated animals did not require exogenous stimulation of α-adrenergic receptor sites by norepinephrine to localize thrombi in the glomerular capillaries when Hageman factor was activated (by ellagic acid) and fibrinolysis inhibited (by ε-aminocaproic acid). It is concluded that glucocorticoids prepare for the generalized Shwartzman reaction by increasing the sensitivity of the microcirculation to stimulation of α-adrenergic receptor sites.     

Inflammation and infarction of adipose tissue: implications in bariatric surgery

Fat necrosis occurs more frequently in patients who have obesity and diabetes mellitus and is linked to worsening of diabetes. Little evidence is available about surgical complications that are related to inflammation and necrosis of adipose tissue. We report two cases of young women with diabetes who underwent bariatric surgery and had complications resulting from extensive inflammation and necrosis of adipose tissue. The first patient was diagnosed with omental infarction, which is a type of fat necrosis that is rarely associated with obesity and bariatric surgery. The second patient had an intraoperative finding of mesenteric panniculitis, which resulted in an intra-operative change in the choice of bariatric surgery to do a sleeve gastrectomy instead of a gastric bypass. Surgeons who perform surgery on bariatric patients must be aware of complications related to excessive amount of adipose tissue.     

Retrospective application of risk scores to ruptured intracranial aneurysms: would they have predicted the risk of bleeding?

Neurosurgical Review - As the incidental diagnosis of unruptured intracranial aneurysms has been increasing, several scores were developed to predict risk of rupture and growth to guide the...     

Quantification of BRCA1 protein in sporadic breast carcinoma with or without loss of heterozygosity of the BRCA1 gene

In sporadic breast cancer, no mutations of the BRCA1 gene have been reported so far, whereas BRCA1 mRNA is markedly decreased in invasive breast cancer. To elucidate the contribution of the BRCA1 gene in sporadic breast cancer, we quantified the BRCA1 protein, using [125I] labeling of whole-cell proteins, lentil-lectin affinity chromatography, immunoprecipitation by anti-BRCA1 antibodies (C-20, D-20, I-20 and K-18), purification of the immune complex by protein A affinity chromatography and chromato-focusing. As loss of 1 allele may lead to a decreased expression of the gene, 10 tumors were previously checked for loss of heterozygosity (LOH) of the BRCA1 gene, using 3 intragenic microsatellite markers. Our results indicated that the BRCA1 gene product was decreased in the 4 tumors with LOH compared with matched normal breast tissues. Reduced amounts of BRCA1 protein were also detected in 3 of 6 tumors without LOH. Our quantitative method allowed us to demonstrate that the BRCA1 protein level was decreased in sporadic invasive breast carcinomas with or without LOH of the BRCA1 gene, implying multiple mechanisms of BRCA1 expression down-regulation in these tumors. Our data suggest that the amount of BRCA1 protein present may play an important role in human sporadic breast carcinoma.     

Oligomeganephronic renal hypoplasia with tapetoretinal degeneration

Summary Bilateral renal hypoplasia with oligomeganephronia, associated with bilateral tapetoretinal degeneration was observed in a child; this association has been reported only once before. Light, ultrastructural and immunofluorescent microscopic studies of the renal tissue were performed. The glomeruli were few and hypertrophic, with numerous mesangial cells, mesangial deposits, focal glomerular sclerosis and prominent thickened basement membrane. Two types of tubular changes were observed: focal necrosis of proximal tubules and focal atrophy of tubules surrounded by a thickened basement membrane. Mild fibrosis with few lymphocytes could be observed in the interstitium. A congenital reduction in the number of nephrons, related to a yet unknown pathological process may explain these morphological changes in part.     

A simple disc technique for the presumptive identification of Legionella pneumophila

A method is described for the presumptive identification of Legionella pneumophila by the formation of satellite colonies around filter paper discs impregnated with ferric pyrophosphate and L-cysteine hydrochloride on a deficient basal medium. This technique simplifies the differentiation of picked colonies of L pneumophila from other organisms in mixed cultures from environmental and contaminated clinical samples.     

Sensitization to the generalized Shwartzman reaction by catechol-O-methyltransferase inhibitors.

The generalized Shwartzman reaction (GSR) was produced by a single injection of endotoxin in male rats pretreated with catechol-o-methyltransferase (COMT) inhibitors (tropolone, pyrogallol). Such a result was not obtained with inhibitors (pargyline, phenelzine, isocarboxazide) of the monoamine oxidase (MAO). The inhibitors of the COMT were found to enhance the action of endotoxin on the coagulation system such as evidenced by the increased consumptions of Hageman factor, fibrinogen, and platelets. Tropolone-treated rabbits did not require exogenous stimulation of alpha-adrenergic receptor sites by norepinephrine to localize thrombi in the glomerular capillaries when Hageman factor was activated by ellagic acid and fibrinolysis inhibited by epsilon-amino-caproic acid. It is concluded that interference with the degradation of circulating catecholamines results in sensitization to the generalized Shwartzman reaction.