The role of the sympathetic nervous system in radiation-induced apoptosis in jejunal crypt cells of spontaneously hypertensive rats

To evaluate the effect of the sympathetic nervous system on radiation-induced apoptosis in jejunal crypt cells, apoptosis levels were compared in spontaneously hypertensive rats (SHR), animals which are a genetic hyperfunction model of the sympathetic nervous system, and normotensive Wistar-Kyoto rats (WKY). SHR and WKY were exposed to whole body X-ray irradiation at doses from 0.5 to 2 Gy. The apoptotic index in jejunal crypt cells was significantly greater in SHR than in WKY at each time point after irradiation and at each dose. WKY and SHR were treated with reserpine to induce sympathetic dysfunction, and were subsequently exposed to irradiation. Reserpine administration to SHR or WKY resulted in a significant suppression of apoptosis. p53 accumulation was detected in the jejunum in both WKY and SHR after irradiation by Western blotting analysis. There were no significant differences in the levels of p53 accumulation in irradiated intestine between WKY and SHR. These findings suggested that hyperfunction of the sympathetic nervous system is involved in the mechanism of high susceptibility to radiation-induced apoptosis of the jejunal crypt cells.     

CT-controlled stereotactic operations for hypertensive intracerebral hemorrhage Part 2: Cases with small hematomas in the thalamus and the basal ganglia

Theoretical principles and actual operative procedures of "CT-controlled stereotactic operations," which was invented by us, have been reported in the previous paper of part 1. In this paper, it is reported 9 cases, 5 of putaminal hemorrhage and 4 of thalamic hemorrhage, who underwent CT-controlled stereotactic operations for evacuation of their small hematomas. Eight patients were male and one patient was female. The age of patients ranged from 42 to 75 years, with a mean age of 62.7 years and there were 3 patients of over 70 years old. And there were 2 patients with poor general condition preoperatively; one had the implantation of pacemaker because of Adams-Stokes syndrome 5 years ago and the other had total gastrectomy because of gastric neoplasm 1 month ago. Eight cases were in acute stage within three days after the onset. Mean operative timing was 14.6 hrs. after the onset. It was very interesting that three cases, 2 of putaminal and 1 of thalamic hemorrhage, had recovered dramatically by this surgery, just like the course after the hematoma evacuation in cases of chronic subdural hematoma. Namely their hemiparesis are decreased remarkably within a few hours after hematoma evacuation. Practically this surgery has minimum risk with simple procedures. The hematoma evacuation can be done easily with high accuracy of stereotaxy. From our experience, potential usefulness of this surgery was positively suggested in the surgical treatment for small ganglionic hematomas as well as thalamic hematomas.     

X-linked lymphoproliferative syndrome presenting with systemic lymphocytic vasculitis

X-linked lymphoproliferative syndrome (XLP) is a rare, often fatal, primary immunodeficiency disease characterized by an abnormal response to Epstein-Barr virus (EBV) infection. The gene responsible for XLP has been identified as SH2D1A/DSHP/SLAM-associated protein (SAP). The major clinical manifestations include fulminant infectious mononucleosis, lymphoproliferative disorder, and dysgammaglobulinemia. Affected males uncommonly present with lymphocytic vasculitis in addition to aplastic anemia. In this study, we describe a Japanese XLP patient who presented with hypogammaglobulinemia following acute EBV-induced infectious mononucleosis in the infancy and later had systemic lymphocytic vasculitis and hemophagocytic lymphohistiocytosis in the adulthood, which resolved by steroid pulse therapy. The patient's SAP gene was found to harbor a missense mutation (His8Asp), presumably resulting in defective expression of SAP in T cells. Biopsy specimens of lung and skin disclosed that CD8+ T cells predominantly infiltrated vascular vessels. However, immunohistochemical examination showed that EBV-infected cells were not identifiable in the vessels. We propose that T-cell-mediated immune dysregulation in XLP can cause vasculitis by EBV infection-unrelated mechanism.     

Delineating the extent of esophageal squamous cell carcinoma

Esophagus - Lugol chromoendoscopy has been conventionally used for the detection and delineation of esophageal squamous cell carcinoma (SCC). However, the boundaries of some lesions are unclear...     

Recurrent Staphylococcus aureus abscess and fatal pneumococcal septicemia due to IRAK‐4 deficiency

We describe the case of an infant with recurrent episodes of staphylococcal skin abscess and subsequent lethal pneumococcal meningitis/septicemia due to interleukin‐1 receptor‐associated kinase 4 (IRAK‐4) deficiency. In this case, systemic signs of inflammatory response were poor and delayed. Among all other reported cases of IRAK‐4 deficiency, none involved severe viral or fungal disease, and the range of infecting bacteria was narrow.     

The impact of postoperative intensive care on outcomes in elective neurosurgical patients in good physical condition: a single centre propensity case-matched study

Purpose

In the last three years, all elective neurosurgical cases were performed by a single surgeon at Nara Medical University. For the last year and a half, all patients were transferred to a newly created neurosurgical intensive care unit. The purpose of this study was to evaluate the impact of admission to an intensive care unit after elective neurosurgery.

Methods

This study was conducted as a retrospective clinical chart review. Institutional ethics approval was waived, and we reviewed the charts of 296 neurosurgical patients who were American Society of Anesthesiologists’ physical status I-II. To avoid channelling bias, propensity score analysis was used to generate a set of matched cases (patients transferred to the intensive care unit [ICU]) and controls (patients transferred to the neurosurgical ward). This process resulted in 104 matched pairs of elective surgical patients who did or did not have an ICU admission after surgery. Glasgow outcome scale (GOS) at discharge or at three months after the operation was compared as the primary outcome measure. As secondary outcome measures, we also compared rates of severe early complications and patient satisfaction regarding perioperative patient care.

Results

With an unmatched population, poor GOS tended to occur more often in the non-ICU group than in the ICU group (6.5% vs 2.3%, respectively). Mortality rates and severe early complication rates also tended to be higher in the non-ICU group than in the ICU group (2.4% and 5.3%, respectively, non-ICU group vs 0.8% and 2.3%, respectively, ICU group). However, after propensity score matching, there was no difference regarding the GOS between groups. Both groups showed very high good outcome percentages (98.1% ICU vs 97.1% non-ICU). With regard to mortality rates and severe early complications, both groups showed low mortality (0.96% vs 0.96%) and complication rates (2.89% ICU vs 3.85% non-ICU). Patient care in the ICU failed to increase patient satisfaction regarding the overall hospital care.

Conclusion

The results of this analysis suggest that admission to an ICU after elective neurosurgery has little impact on outcomes.