Bench-to-bedside review: Apoptosis/programmed cell death triggered by traumatic brain injury

Despite continuous advances in technologic and pharmacologic management, the mortality rate from septic shock remains high. Care of patients with sepsis includes measures to support the circulatory system and treat the underlying infection. There is a substantial body of knowledge indicating that fluid resuscitation, vasopressors, and antibiotics accomplish these goals. Recent clinical trials have provided new information on the addition of individual adjuvant therapies. Consensus on how current therapies should be prescribed is lacking. We present the reasoning and preferences of a group of intensivists who met to discuss the management of an actual case. The focus is on management, with emphasis on the criteria by which treatment decisions are made. It is clear from the discussion that there are areas where there is agreement and areas where opinions diverge. This presentation is intended to show how experienced intensivists apply clinical science to their practice of critical care medicine.     

DDAVP in type IIa von Willebrand's disease

1-D-Amino(8-D-arginine)-vasopressin (DDAVP) infusion in three patients with type IIa von Willebrand's disease (vWD) resulted in a normalization of the factor VIII coagulant, factor VIII-related antigen, and von Willebrand factor (vWF) (ristocetin cofactor) activities and the bleeding time. The normalization of these hemostatic parameters persisted for four hours. Over the same time period there was a marked increase in the quantity of the vWF multimers when blood was collected in the presence of protease inhibitors. The vWF multimers present were even larger than the normal. When blood was collected in the absence of protease inhibitors, a smaller increase in the plasma vWF multimers was observed and fewer of the intermediate and larger vWF multimers were seen; multimers larger than those present in normal plasma were not visualized. The platelet vWF multimers and activities did not change with or without inhibitors. These studies suggest that there is a subgroup of patients with type IIa vWD who respond to DDAVP with complete normalization of their hemostatic abnormalities and whose vWF is sensitive to proteolysis.     

Benign lichenoid keratosis due to constant pressure

Two well-circumscribed keratotic plaques in an elderly man, one each on symmetrically. identical over the sides of the buttocks, are described. Clinical and histopathological features supported the diagnosis of benign lichenoid keratosis, which had probably resulted from constant pressure over the site and regressed when this factor was eliminated.     

维甲酸与二甲基亚砜诱导HL-60细胞及其抗性亚型MDR 1的表达和对Rhodamine-123外排的影响

利用Dot blot 和流式细胞术，研究了分化诱导剂维甲酸，DMSO对HL-60细胞及其抗性亚型抗药性程度的影响，表明1μmol·ml^-1 RA 作用H-60及其亚型24h， MDR 1 mRNA 明显增高，但流式检测多药抗性细胞系对Rho-123的外排有所下降。2%DMSO作用HL-60及其亚型 24h，流式细胞术检测显示各细胞系对Rho-123 的外排明显增强，提示RA 虽然提高MDR 1基因的表达，但可能通过磷酸化/脱磷酸化方式抑制Pgp-170功能的表达，而DMSO能诱导完整功能的Pgp表达。     

中药葛根及其同属植物的资源利用和评价

对我国葛属（ＰｕｅｒａｒｉａＤＣ，）９种和１变种植物进行了调查研究，认为目前国内市售中药葛根的主流品种为野葛Ｐ，ｌｏｂａｔａ（Ｗｉｌｌｄ．）Ｏｈｗｉ和粉葛Ｐ．ｔｈｏｍｓｏｎｉｉ）Ｂｅｎｔｈ．。野葛在我国大部份省区都有分布，资源最为丰富；粉葛在广西载培历史悠久；其他种主要分布在西南地区，并有少数种在当地作中药葛根用。从成分分析结果看，野葛的葛根素（ｐｕｅｒａｒｉｎ）及总黄酮含量显著高于本属其它植物，粉葛次之。除野葛和粉葛外其他种均不宜作葛根药用。峨嵋葛Ｐ．ｏｍｅｉｅｎｓｉｓＷａｎｇｅｔＴａｎｇ是个有争议的种，我们比较了化学成分的含量，其结果与粉葛相近，而与山葛藤有所区别，有待进一步研究。     

Hidden risks for pneumonia in Malawi

Domestic smoke exposure and early HIV infection are critical but unseen risk factors for pneumonia. This paper reviews how recent research in Malawi and elsewhere contributes to an understanding of the possible immunological mechanisms underlying these risks.     

Parathyroid variants: US evaluation

High-resolution (10-MHz) ultrasonography was performed in 181 patients with primary or secondary hyperparathyroidism during a 4-year period and evaluated retrospectively. Thirty-seven unusual-appearing parathyroid tumors were found among 235 parathyroid glands identified as abnormal. There was pathologic correlation in 36. The typical appearance of parathyroid adenoma was that of an oval hypoechoic or anechoic lesion in the neck, aligned in a craniocaudal direction and often posterior to the thyroid. Morphologic variations from the norm included giant size (n = 11) (4.6%), cystic changes in a solid tumor (n = 9) (3.8%), calcified glands (n = 6[in three patients]) (2.5%), a multilobulated configuration (n = 5) (2.1%), an inhomogeneous pattern (n = 5) (2.1%), and a parathyroid cyst (n = 1) (0.4%). Recognizing the abnormal parathyroid variants can increase the diagnostic accuracy of sonographic examination.     

Tracheobronchial stenosis in infants: successful balloon dilation therapy

Four infants with congenital or acquired tracheobronchial stenosis were successfully treated with angioplasty balloon catheter dilation. The technical details and complications of these procedures are described. The authors believe balloon dilation therapy should be considered as the initial form of therapy for tracheal stenosis in infants, even in the presence of complex stenotic lesions.