Association of head trauma with cervical spine injury, spinal cord injury, or both

BACKGROUND: Links between cervical spine and/or spinal cord injuries and head trauma have not been reported in detail. METHODS: 188 patients with cervical spine and/or spinal cord injury were divided into two groups, i.e., with upper cervical and mid-lower cervical injury, and compared for head injury. RESULTS: Associated head trauma was investigated in 188 patients with cervical spine and/or spinal cord injuries; 35% had moderate or severe injuries. Brain damage was more frequently observed in patients with upper cervical injury than in those with mid to lower cervical injury. Those patients with upper cervical injury appeared to have an elevated risk of suffering skull base fractures, traumatic subarachnoid hemorrhage, and contusional hemotoma. CONCLUSIONS: Approximately one third of patients with cervical spine and/or spinal cord injuries had moderate or severe head injuries. Brain damage was more frequently associated with upper cervical injury. Those patients with upper cervical injury are at greater risk of suffering from skull base fractures and severe intracranial hematomas than those with mid to lower cervical injury.     

Effects of transfusion on gastrointestinal anastomotic wound healing and leukocyte function in rats

BACKGROUND: This study was done to investigate the effects of blood transfusion on gastrointestinal anastomotic wound healing and leukocyte function. METHODS: Closed-colony male Wistar rats were divided into five groups in a group-mixed fashion and underwent laparotomy (the CONT and WB groups) or gastrectomy and gastroduodenostomy (the GAST, GAST/WB and GAST/LDRWB groups). Immediately, they received 3 ml of saline (the CONT and GAST groups) or blood from Wistar donors (the WB and GAST/WB groups, whole blood; the GAST/LDRWB group, a transfusion of irradiated and leukocyte-depleted whole blood). The animals were killed 7 days after surgery. RESULTS: The GAST/WB group had a higher incidence of anastomotic abscess, a lower level of factor XIII and a lower maximum breaking strength than the GAST group. Gastrectomy decreased L-DCL (luminol-dependent chemiluminescence) more than whole-blood transfusion. In the GAST/WB group, L-DCL was severely reduced, while in the GAST/LDRWB group it was roughly equivalent to the level in the GAST group. CONCLUSIONS: Whole-blood transfusion increased the incidence of anastomotic abscess and impaired anastomotic wound healing, and these might relate to the reduction of L-DCL. Irradiated and leukocyte-depleted transfusion can improve these effects.     

A case of metachronous cholangiocellular and hepatocellular carcinoma with good prognosis

A 63-year-old man was treated for 6 months with interferon (IFN) for chronic hepatitis C but the treatment failed to eradicate hepatitis C virus. Six months after completion of IFN therapy, cholangiocellular carcinoma (CCC) was detected in the posterior inferior segment and was resected surgically. He had been in good condition except for diabetic nephropathy progressing to renal failure at 3 years after the resection of CCC. Seven years after the resection of CCC, hepatocellular carcinoma (HCC) was detected in the posterior superior segment of the liver. The tumor was pathologically confirmed by fine needle aspiration biopsy. The patient was successfully treated with two courses of percutaneous ethanol injection and has been well 1 year after the treatment. HCV status did not change as genotype 1b with moderate viral load (300 to 500 kilo copies/mL by amplicore monitoring) during the follow-up. Thus, even though the patient was treated with IFN, hepatitis C could progress to not only HCC but also CCC in the same patient. Our patient is still alive, 9.5 years after detection of the first tumor.     

Deciphering Subtype-Selective Modulations in TRPA1 Biosensor Channels

The transient receptor potential (TRP) proteins are a family of ion channels that act as cellular sensors. Several members of the TRP family are sensitive to oxidative stress mediators. Among them, TRPA1 is remarkably susceptible to various oxidants, and is known to mediate neuropathic pain and respiratory, vascular and gastrointestinal functions, making TRPA1 an attractive therapeutic target. Recent studies have revealed a number of modulators (both activators and inhibitors) that act on TRPA1. Endogenous mediators of oxidative stress and exogenous electrophiles activate TRPA1 through oxidative modification of cysteine residues. Non-electrophilic compounds also activate TRPA1. Certain non-electrophilic modulators may act on critical non-cysteine sites in TRPA1. However, a method to achieve selective modulation of TRPA1 by small molecules has not yet been established. More recently, we found that a novel N-nitrosamine compound activates TRPA1 by S-nitrosylation (the addition of a nitric oxide (NO) group to cysteine thiol), and does so with significant selectivity over other NO-sensitive TRP channels. It is proposed that this subtype selectivity is conferred through synergistic effects of electrophilic cysteine transnitrosylation and molecular recognition of the non-electrophilic moiety on the N-nitrosamine. In this review, we describe the molecular pharmacology of these TRPA1 modulators and discuss their modulatory mechanisms.     

Small ileal neurofibroma causing intussusception in a non-neurofibromatosis patient

Neurofibromas in the small intestine are usually accompanied by von Recklinghausen's disease (neurofibromatosis), and usually originate in the intramuscular plexus of Auerbach. We present here a solitary neurofibroma, which caused an ileocolic intussusception, originating in the submucosal plexus of Meissner in a non-neurofibromatosis patient. To our knowledge, there is no previous report of a neurofibroma originating in the plexus of Meissner. This condition was clearly confirmed by macroscopic and microscopic evaluation.     

Liver metastasis of rectal cancer with intraluminal growth in the extrahepatic bile duct

Metastatic liver tumors are considered to have a tendency for expansive growth and rarely invade the bile duct. We recently encountered a resected case of liver metastasis from rectal cancer with intraluminal growth in the extrahepatic bile duct with a successful left trisegmentectomy of the liver. A 54-year-old woman underwent a posterior total pelvic exenteration for advanced rectal cancer. Ultrasonography and computed tomography four months after the first operation demonstrated a solitary occupied lesion in the liver with dilation of the left hepatic duct. Endoscopic retrograde cholangiopancreatography disclosed a filling defect in the intra- to extrahepatic bile duct. Liver metastasis from rectal cancer with intraluminal growth in the bile duct was suspected despite a consideration of primary bile duct cancer. A left trisegmentectomy of the liver and resection of the extrahepatic bile duct with a right hepatojejunostomy were performed. The tumor had invaded the intrahepatic bile duct and had developed intraluminally in the extrahepatic bile duct. Tumor thrombi were microscopically found in the bile duct of the left caudal lobe. Liver metastasis arising from colorectal cancer with intraluminal growth in the bile duct is rare, however we encountered such a case with a successful resection involving a left trisegmentectomy of the liver.     

The resection of non-hepatic intraabdominal recurrence of gastric cancer

BACKGROUND/AIMS: Surgical resection of hepatic or pulmonary metastases from gastrointestinal cancer has been recognized as a curative modality in some patients. However, the role and outcome of the surgical management of a non-hepatic intraabdominal recurrence of gastrointestinal cancer have not been clearly delineated. METHODOLOGY: We treated 5 patients for non-hepatic intraabdominal recurrence of gastric carcinoma surgically. All the resected specimens were microscopically identified as recurrent gastric cancer. Three of 5 patients received postoperative chemotherapy. The clinicopathological findings were analyzed according to the general rules for gastric cancer study. RESULTS: The lymph nodes were dissected for lymph node metastases. Surgical resection of the tumors combined with total gastrectomy, esophagectomy, or colectomy was performed for the local and peritoneal recurrences. All of the recurrent tumors were macroscopically resected with curative states. One patient died of sepsis 54 days after surgery. Three patients died of recurrent gastric cancer: 2 within 1 year of surgery and 1 after 3 years. One patient still survives disease free 3 years and 6 months after the 2nd operation. CONCLUSIONS: Surgical resection for non-hepatic intraabdominal recurrence of gastric cancer is the treatment of choice for selected patients. Surgical resection followed by adjuvant chemotherapy may improve the outcome of these patients.