Acute limb ischemia due to malignant arterial embolism from a metastatic germ cell tumor

Arterial tumor embolization is a rare but serious complication of neoplastic disease. The majority of these tumors are associated with primary or secondary lung malignancies, originating from pulmonary vein metastasis or from an atrial mass. Malignant germ cell tumors primarily disseminate to the retroperitoneal lymph nodes and lung, and to the brain and liver later in the course of the disease. A germ cell tumor metastasis embolizing to the iliac-femoral arterial system has not yet been reported. We report a metastatic embolism in a patient with disseminated embryonal cell carcinoma causing acute limb ischemia, managed by surgical embolectomy. The sudden development of limb ischemia in a patient with a germ cell tumor should alert the physician to the possibility of tumor embolism. © 1995 Wiley-Liss, Inc.     

Pulmonary arterio-venous fistulae in hepatic cirrhosis

Cyanosis, clubbing, and arterial oxygen desaturation may occur in patients with liver disease, and are attributed to the presence of pulmonary or peripheral arterio-venous shunting. Cardiac catheterisation and angiocardiography in a patient with a normal heart did not demonstrate the presence of abnormal arterio-venous anastomoses. Pulmonary shunting was proved when intravenous technetium-labelled macroaggregated albumin, normally held up in capillary networks, was passed quickly through the lungs and immediately detected in high systemic blood flow organs. The opening of peripheral and pulmonary anastomoses in patients with liver disease may be owing to the presence of a vasodilatory substance such as ferritin, which was found to be abnormally increased in the patient's blood.     

The correction of anemia in severe resistant heart failure with erythropoietin and intravenous iron prevents the progression of both the heart and the renal failure and markedly reduces hospitalization

Both Congestive Heart Failure (CHF) and Chronic Renal Failure (CRF) are increasing steadily in the community. We propose that there is a vicious circle established whereby CHF and CRF both cause anemia and the anemia then worsens both the CHF and CRF causing more anemia and so on. We call this the Cardio Renal Anemia (CRA) syndrome. By the combination of active treatment of the CHF and control of the anemia with subcutaneous erythropoietin and intravenous iron, the progression of both the CHF and the CRF can be slowed or stopped in most cases, the quality of life improved and the need for recurrent hospitalization reduced. This will involve cooperation between internists, cardiologists, and nephrologists to allow early and maximal therapy of both the CHF and the anemia.     

A population-based study of help-seeking for self-harm in young adults

OBJECTIVE: To examine help-seeking for self-harm in a population-based sample of young adults. METHOD: Nine hundred and sixty-five participants aged 26 years were interviewed about help-seeking and barriers to help-seeking for a range of self-harmful behaviours. Self-harm included the traditional methods of suicide (ICD-9 self-harm) and other self-harmful behaviours such as self-battery and self-biting. RESULTS: Just over half of the 25 in the ICD-self-harm group (based on ICD-9 self-harm criteria) and one-fifth of the 119 in the other self-harmful behaviour group had sought professional help. Counsellors, psychologists, and general practitioners were the commonest sources of help. Most participants rated help received from health services favourably, however, emergency services were rated less favourably than other health services. Among 77 self-harm participants who did not seek help, just over one-third reported attitudinal barriers. CONCLUSIONS: To encourage help-seeking by young adults who self-harm, especially young men who are at high risk for self-harm and suicide, it may be necessary to identify ways to reduce attitudinal barriers.     

Consumption of L-arginine mediated by Entamoeba histolytica L-arginase (EhArg) inhibits amoebicidal activity and nitric oxide production by activated macrophages

In this study we discuss the cloning and expression of Entamoeba histolytica arginase (EhArg), an enzyme that catalyses the hydrolysis of L-arginine to L-ornithine and urea. L-norvaline, a competitive inhibitor of E. histolytica L-arginase, inhibits the growth of the parasite, which suggests that the catabolism of L-arginine mediated by EhArg is essential. Nitric oxide (NO) is an antimicrobial agent that inhibits some key enzymes in the metabolism of Entamoeba histolytica. NO is synthesized by activated macrophages from L-arginine, the substrate of NO synthase (NOS-II). We show that E. histolytica inhibits NO mediated amoebicidal activity of activated macrophages by consuming L-arginine present in the medium.     

Assessing the motor status score: a scale for the evaluation of upper limb motor outcomes in patients after stroke

The Motor Status Scale (MSS) measures shoulder, elbow (maximum score = 40), wrist, hand, and finger movements (maximum score = 42), and expands the measurement of upper extremity impairment and disability provided by the Fugl-Meyer (FM) score. This work examines the interrater reliability and criterion validity of the MSS performed in patients admitted to a rehabilitation hospital 21 +/- 4 days after stroke. Using the MSS and the FM, 7 occupational therapists masked to each other's judgments, evaluated 12 consecutive patients with stroke. Two therapists evaluated 6 additional patients on consecutive days. Intraclass correlation coefficients were significant for each group of raters for the shoulder/elbow and for the wrist/band (P < 0.0001); test-retest measures were also significant for the shoulder/elbow (Pearson correlation coefficient r = 0.99, P < 0.004) and for the wrist/hand (Pearson correlation coefficient r = 0.99, P < 0.003). The internal item consistency for the overall MSS was significant (Cronbach alpha = 0.98, P < 0.0001). Finally the correlation between the MSS and the FM (R2 = 0.964) was significant (P < 0.0001). The MSS affords a reliable and valid assessment of upper limb impairment and disability following stroke.     

榄香烯和姜黄素诱导晶状体上皮细胞凋亡的超微结构改变

目的观察榄香烯（Ele）、姜黄素（Cur）对体外培养的牛晶状体上皮细胞（LECs）凋亡的超微结构的影响。方法分别用160μg／mlEle，20μg／ml Cur与LECs共同孵育24、48、72h，采用透射电子显微镜观察LECs超微结构的变化。结果Ele和Cur作用不同时间的LECs均出现核染色质凝集、固缩、边集等典型的凋亡形态学改变，呈时一效依赖关系。超微结构研究显示，Cur诱导凋亡的同时，也诱导发生细胞胀亡。结论Ele和Cur具有明显诱导LECs凋亡或胀亡的作用。     

Postoperative Pain Management and Proinflammatory Cytokines: Animal and Human Studies

The postoperative period is associated with neuroendocrine, metabolic, and immune alterations, which are the combined result of tissue damage, anesthesia, postoperative pain, and psychological stress. Limited evidence indicates that pain management in the postoperative period can affect the outcome of the surgery, reducing cardiac, pulmonary, and metabolic complications. Recent evidence indicates that pain and immune factors, especially proinflammatory cytokines, mutually interact and influence each other. A series of animal studies demonstrates that effective preemptive analgesia improved postoperative recovery, and this effect was enhanced by coadministration of IL-1ra together with the preemptive analgesics. Furthermore, preemptive analgesia attenuated surgery-induced PGE₂ production in the amygdala and the activation of the HPA axis. IL-1 signaling is required for the production of amygdala PGE₂ in response to surgical stress, and may thus affect the physiological and psychological aspects of surgical stress. These reports suggest that short-term effective analgesia can have long-lasting beneficial effects on surgery recovery. They further suggest that IL-1 blockade should be considered in the clinical management of pain associated with peripheral or nerve injury. Another series of human studies describes an interaction between the effectiveness of postoperative pain relief and surgery-associated immune alterations: In three separate studies, the more effective pain management technique was associated with diminished surgery-induced immune alterations, especially diminished elevation of IL-1. Reduced elevation of postoperative IL-1 and effective pain relief may both contribute to an attenuated illness response and a better surgery outcome.Presented at the 12th SNIP Conference, Santa Fe, New Mexico, April 5–9, 2006.     

Mesenchymal Hamartoma of the Liver in Children： a Report of Four Cases

OBJECTIVE Mesenchymal hamartoma of the liver (MHL) is a rare disease that makes up about 5%-8% of primitive hepatic tumors in children. The etiology of MHL has been the subject of considerable discussion. The possibility of malignant transformation of MHL is inclusive. To enhance the recognition of MHL in children, we have review the procedures in diagnosis and treatment and present 4 of our own cases. METHODS The clinical characteristics of MHL in 4 children including history, physical examination, lab examination, imaging data and pathology were analyzed and discussed and related to reports from the literature. RESULTS All the cases were diagnosed with B-ultrasonography and CT preoperatively, and were confirmed intra-operatively and histologically. Satisfactory results were reached postoperatively. CONCLUSION MHL is an uncommon benign lesion in children. The main presentation is abdominal painless mass. Diagnosis is aided with B-ultrasonography and CT preoperatively. Complete tumor removal is the best choice for MHL treatment resulting in a good outcome.