Diaphragmatic Hernia Masquerading as a Pulmonary Metastasis

Iatrogenic injury accounts for the second most common cause of acquired diaphragmatic hernias after penetrating trauma. An increased incidence of these hernias has been observed with the widespread use of laparoscopic surgery. We present the case of a 65-year-old woman who initially underwent sigmoid resection for an adenocarcinoma and a subsequent liver resection for metastasis. She was noted to have a left lower lobe pulmonary nodule on surveillance computed tomography, for which she underwent a mini-thoracotomy for a planned resection. At the time of surgery, the pulmonary nodule was discovered to be a diaphragmatic hernia, most probably of iatrogenic origin. We discuss the difficulty in diagnosis given her history and the location of such a lesion.     

A new method for evaluation of portasystemic shunting. The rectal octanoate tolerance test

Hepatic clearance of a small dose of a medium chain fatty acid was used to estimate portasystemic shunting in patients with cirrhosis. Sodium octanoate dissolved in isotonic saline was administered by rectum (11.4 mg per kg of lean body mass) in three groups of 10 patients with cirrhosis and in 10 noncirrhotic controls. Two groups of patients were classified as mild and severe cirrhotics on the basis of a clinical evaluation. The third group of cirrhotic patients had a surgical portacaval shunt. Serum octanoate levels were measured in each subject for a 1-hr period following the administration of sodium octanoate by rectum. A highly significant difference (P less than 0.001) was demonstrated between all four groups of subjects with highest levels occurring in the shunted cirrhotics and the lowest levels in the control group. Serum levels obtained in 2 patients before and after a portacaval shunt increased by a factor of 2 following the operation. Two patients with proven occlusion of a surgical shunt fell well within the range of the nonoperated cirrhotic patients. The results suggest that the rectal octanoate tolerance test can probably be used for evaluation of collateral circulation in cirrhotic patients and for testing the patency of surgical shunts.     

Diffuse esophageal spasm: a reappraisal

With the renewed interest in esophageal motility disorders, diffuse esophageal spasm is being diagnosed more frequently. In many clinical settings, however, the term is used as a synonym for noncardiac chest pain. Our review of the literature and broad clinical experience in studying the motility patterns of healthy subjects have helped us better define diffuse esophageal spasm. The diagnosis of diffuse esophageal spasm should be considered only in symptomatic patients showing simultaneous contractions after wet swallows during esophageal motility testing. Simultaneous contractions should occur after at least 10% of swallows and be intermixed with normal peristaltic contractions. Repetitive waves, contractions of prolonged duration, spontaneous activity, high-amplitude contractions, and lower esophageal sphincter abnormalities may be seen in diffuse esophageal spasm. None of these findings alone or in combination justifies a diagnosis of diffuse esophageal spasm unless associated with simultaneous esophageal contractions.     

Seropositivity for pathogens associated with chronic infections is a risk factor for all-cause mortality in the elderly: findings from the Memory and Morbidity in Augsburg Elderly (MEMO) Study

GeroScience - Immunostimulation by chronic infection has been linked to an increased risk for different non-communicable diseases, which in turn are leading causes of death in high- and...     

山奈酚通过抑制NLRP3炎症小体介导的脂肪组织炎症改善db/db小鼠胰岛素抵抗发生

目的：探讨山奈酚能否通过调控肥胖小鼠脂肪组织炎症改善胰岛素抵抗发生并研究作用机制。方法：db/m小鼠作为对照组,db/db雄性小鼠随机分为模型组、二甲双胍组(0.15 g·kg^-1·d^-1)和山奈酚组(50 mg·kg^-1·d^-1)。连续灌胃给药6周,每周记录小鼠体重,6周后进行葡萄糖耐量试验、胰岛素耐量试验、皮下和附睾白色脂肪组织质量测定;HE染色观察脂肪组织形态学变化,免疫组化法观察巨噬细胞向脂肪组织的浸润程度及巨噬细胞标志物F4/80的表达,实时荧光定量PCR检测TNF-α和IL-18以及Arg-1和IL-10的mRNA表达,蛋白质免疫印迹试验检测NLRP3、pro-caspase1、cle-caspase1和IL-1β表达。结果：与模型组相比,山奈酚能够显著抑制db/db小鼠脂肪质量增加,抑制脂肪细胞肥大。山奈酚组小鼠脂肪组织巨噬细胞浸润减少,TNF-α和IL-18 mRNA表达减少,Arg-1和IL-10 mRNA表达增加;山奈酚治疗能够抑制小鼠附睾脂肪组织NLRP3、caspase1以及...     

The Role of Minerals in the Optimal Functioning of the Immune System

Minerals fulfil a wide variety of functions in the optimal functioning of the immune system. This review reports on the minerals that are essential for the immune system’s function and inflammation regulation. We also discuss nutritional aspects of optimized mineral supply. The supply of minerals is important for the optimal function of the innate immune system as well as for components of adaptive immune defense; this involves defense mechanisms against pathogens in addition to the long-term balance of pro- and anti-inflammatory regulation. Generally, a balanced diet is sufficient to supply the required balance of minerals to help support the immune system. Although a mineral deficiency is rare, there are nevertheless at-risk groups who should pay attention to ensure they are receiving a sufficient supply of minerals such as magnesium, zinc, copper, iron, and selenium. A deficiency in any of these minerals could temporarily reduce immune competence, or even disrupt systemic inflammation regulation in the long term. Therefore, knowledge of the mechanisms and supply of these minerals is important. In exceptional cases, a deficiency should be compensated by supplementation; however, supplement over-consumption may be negative to the immune system, and should be avoided. Accordingly, any supplementation should be medically clarified and should only be administered in prescribed concentrations.