Differential effect of tacrolimus on dermal and intestinal wound healing.

Tacrolimus, used in organ transplantation, inhibits cellular immune function. Little is known about the effect on dermal and colonic healing. Groups of 10 rats underwent dorsal skin incision, and polyvinyl alcohol sponges were implanted subcutaneously. Beginning at the day of wounding, rats were treated intraperitoneal with 1.0 or 2.0 mg tacrolimus/kg/day. Animals were sacrificed 10 d later to determine wound breaking strength and reparative collagen deposition. Expression of transforming growth factor (TGF)-beta, tumor necrosis factor (TNF)-alpha, and interferon (IFN)-gamma was studied in wounds. Groups of 8 rats underwent laparotomy and left colonic anastomosis. These rats were treated by subcutaneous injections with 2.0 or 5.0 mg tacrolimus/kg. Animals were sacrificed 5 d later to test colonic bursting pressure and reparative collagen deposition. Expression of TGF-beta, TNF-alpha, IFN-gamma, and CD4 and CD8 in the anastomosis was investigated. Tacrolimus impaired dermal healing (p < .05). This was paralleled by decreased expression of TGF-beta (stimulates healing) and increased expression of IFN-gamma and TNF-alpha (both inhibit healing) (p < .05). In contrast, tacrolimus did not inhibit healing of colonic anastomoses. No effect was seen on the expression of TGF-beta, TNF-alpha, IFN-gamma, and CD4 and CD8 in colonic anastomoses. We concluded that tacrolimus differentially effects tissue healing and expression of cellular mediators in dermal and intestinal wounds.     

Hepatic Resection in the Elderly

p = 0.02) and for primary neoplasia of the liver ( p = 0.002) but not for metastatic disease to the liver. This reflects the high rate of cirrhosis in hepatocellular and cholangiocellular carcinoma (88%) and gallbladder cancer (37.5%). Both pre- and postoperative severe liver dysfunction had a significantly higher risk for postoperative mortality and morbidity, which showed an incremental risk with age. Another organ system able to predict outcome at the beginning of treatment by its moderate severe dysfunction were the lungs. Overall, only right and extended right lobectomies carried a significantly higher risk for postoperative mortality and morbidity. Postoperative complications were recorded in 43% of our patients, with infection the most frequent problem in nearly all of these patients (95%). Pneumonia was the leading complication associated patient survival. All patients who developed pneumonia as a late complication during a complicated postoperative course died postoperatively. The postoperative Goris score of the patients who died was 6.9 ± 2.9 (range 3–11), whereas the surviving patients’ score averaged 2.2 ± 1.9 (range 0–9), which was significantly different ( p = 0.0003). None of the 54 patients with a GORIS score ≤ 2 died postoperatively, whereas 5 of 6 patients with a score ≥ 9 died ( p = 0.0001). Severe liver dysfunction rather than the extent of resection influences clinical mortality. Patients > 80 years of age with a preoperative severe liver dysfunction showed a postoperative mortality of 57%, and all of these patients developed postoperative complications. Therefore resection cannot be recommended for those patients. Cirrhosis led to an unacceptable mortality of 44% after hepatic resection of ≥ 5 liver segments for primary neoplasia of the liver. Major resections cannot be recommended in the aged with gallbladder cancer because 50% of the patients died after such operations. Overall, only resection of ≥ 5 liver segments with segments I to III or less remaining were found to pose a major risk for clinical mortality and morbidity, but the cause of death was preexisting liver dysfunction and cirrhosis in all of these patients. Major resections of large neoplasia of the liver can be recommended even in the aged, but a preoperative preselection of patients with respect to liver function and pulmonary function preoperatively may help lower the postoperative morbidity and mortality, especially in patients who will undergo resection of ≥ 5 liver segments. Major hepatic resection for metastatic disease to the liver in the elderly carries no additional survival risk. Patients > 65 years of age and especially those > 80 years of age are more liable to succumb to postoperative organ failure and complications, especially infections.     

Transmission line for improved RF safety of interventional devices.

A new concept is proposed to improve the safety of transmission lines with respect to heating during RF transmission. It is based on the integration of transformers into the transmission line. The concept was applied to an active tracking device. Miniature transformers were designed, and two types of tracking devices were built based on a standard line and a transformer line. Temperature measurements were performed for both devices during high specific absorption rate (SAR) scanning, and the suppression of RF heating to a physiologically non-relevant level was demonstrated for the transformer device. The transmission properties of the transformer line were examined in simulations and RF measurements. Active tracking with the transformer device performed robustly in the phantom. Because of the favorable signal transmission properties of the tested device, it is expected that the concept can be applied to the construction of clinical devices for tracking and intravascular imaging, which are RF-safe under clinical SAR conditions. Since the transformer line has a large bandwidth, the concept may also be applied for RF-safe transmission of non-MR signals.     

Tödliche Harnblasenruptur bei Blasentamponade nach transurethraler Resektion der Prostata

We report the case of a 74-year-old man with a non-traumatic intraperitoneal rupture of the urinary bladder. On the eighth postoperative day following transurethral resection of the prostate (TUR-P), the patient developed massive, diffuse parenchymal bleeding from arterial vessels in the prostate base. After urinary bladder tamponade with consecutive rupture of the bladder, peritonitis and sepsis occurred with fatal outcome. A traumatic origin of the bladder rupture during TUR-P was excluded by means of the inconspicuous course following the intervention and due to the fact that postoperative contrast radiography of the bladder and resection site showed no leakage of radiopaque fluid. Underlying diseases predisposing to spontaneous bladder rupture such as cystitis, tumour, diverticulum or radiation disease could be excluded by histology. To the best of our knowledge, spontaneous rupture of the urinary bladder following bladder tamponade has not been reported. The occurrence of bladder tamponade following late bleeding complications after TUR-P has also not been described previously.     

Induction of IL-5 expression by IL-2 is resistant to the immunosuppressive agents cyclosporin A and rapamycin

T cell cytokine expression may be induced by the cytokine IL-2 or via the TCR complex. The comparative effects of cytokine- and TCR-mediated signalling on the induction of human IL-5 mRNA were examined. Cytokine mRNA expression was analysed by RT-PCR in fresh peripheral blood mononuclear cells (PBMC) from normal individuals and in populations of activated T lymphocytes, derived from phytohaemagglutinin (PHA)- stimulated PBMC. rIL-2 induced IL-5 expression in PBMC, the kinetics of which were similar to the effects of PHA. rIL-4 induced IL-5 mRNA expression in activated T lymphocytes. IL-5 expression induced by either IL-2 or PHA was completely abolished by the protein synthesis inhibitor cycloheximide. rIL-2-induced IL-5 expression was resistant to cyclosporin A (CsA), whereas IL-5 expression elicited by PHA was inhibited by CsA, at doses as low as 10 ng/ml. Rapamycin (RAP) had no effect on rIL-2-stimulated IL-5 expression, but suppressed IL-5 expression induced by PHA. The inhibitory effect of RAP on PHA-induced IL-5 expression was more apparent at 12 and 24 h after stimulation than at earlier times. The resistance of IL-2 receptor (IL-2R) signalling to CsA and RAP indicates that the IL-2R and the TCR are associated with different pathways regulating IL-5 expression.      

Examination of postmortem animal interference to human remains using cross-species multiplex PCR

Postmortem animal interference may be confused at first sight with injuries of vital origin, thus arousing suspicion of external violence preceding death. A reliable classification of the origin of such doubtful injuries is of crucial importance, a fact that is especially true for the investigation of suspected homicide and/or mammade body mutilation after death. In forensic pathology, the identification of injuries as caused by animals postmortem and the classification of a particular species as responsible for a specific injury pattern under question is usually done by forensic pathologists with vast practical experience and special knowledge of the appearance and morphology of tooth marks of carnivores and rodents, respectively. However, a molecular biological investigation of such wounds could provide genetic evidence that an injury pattern present on a corpse was truly caused postmortem by animal interference and thus support the pathologist's expertise. For this purpose, we developed a panel of small species-specific short-tandem repeat systems (<150 bp) for animals typically involved in postmortem scavenging of human remains, such as dogs and cats as well as wild-living rodents (mice and rats) having possible access to death scenes inside apartments or buildings. A specific and sensitive cross-species multiplex polymerase chain reaction was then established including the species-specific animal markers, thus enabling the genetic identification of wounds caused postmortem by different animals on human remains. This study was presented at the Sixth International Symposium in Advanced Legal Medicine (ISLAM), Hamburg, Germany, September 2006.     

Detection of IgE antibodies specific for 1-phenyl-2,3-dimethyl-3-pyrazoline-5-one by RAST: a serological diagnostic method for sensitivity to pyrazoline drugs.

Certain adverse reactions to pyrazoline drugs resemble IgE-mediated hypersensitivity. However, convincing evidence of antigen-antibody interactions is not fully demonstrated. In this study, IgE antibodies specific for 1-phenyl-2,3-dimethyl-3-pyrazoline-5-one have been found in 17 out of 19 serum samples from individuals sensitive to pyrazoline drugs with 4-aminoantipyrine discs by Radio Allergo Sorbent Test (RAST). In contrast, we have not found any positive results from 10 normal donors without sensitivity to pyrazoline drugs after ingestion of metamizol 500 mg/day for 14 days. Therefore, our results provide further evidence in favor of an IgE-dependent mechanism in patients suffering from sensitivity to pyrazoline drugs. The determination of specific IgE antibodies could be used as a serodiagnostics method.