Mechanism of adrenal insufficiency following trauma and severe hemorrhage: role of hepatic 11beta-hydroxysteroid dehydrogenase

BACKGROUND: Although adrenal insufficiency may not occur with moderate hypotension, it does occur with severe hemorrhage. Since hepatocellular function is depressed following severe hemorrhage, it remains unknown whether the liver plays any role in regulating adrenal function after trauma and hemorrhagic shock. HYPOTHESIS: Hepatic 11beta-hydroxysteroid dehydrogenase (11beta-HSD), a microsomal enzyme responsible for the degradation of bioactive corticosterone, plays a major role in the development of adrenal insufficiency following trauma and severe hemorrhage. DESIGN, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Male rats underwent laparotomy to induce trauma before hemorrhage. They were then bled to and maintained at a blood pressure of 40 mm Hg until 40% of the maximal bleed-out volume was returned in the form of Ringer lactate. The rats were then resuscitated with 4 times the volume of maximal bleed-out with Ringer lactate during a 60-minute period. Plasma levels of corticosterone and corticotropin were measured at various intervals. In additional groups, corticotropin-induced corticosterone release, adrenal contents of corticosterone and cyclic adenosine monophosphate (cAMP), hepatic 11beta-HSD activity, and plasma levels of corticosterone-binding globulin were determined at 1.5 hours after resuscitation. Moreover, a model of moderate hypotension (blood pressure, 80 mm Hg) was used to determine whether adrenal function is depressed under such conditions. RESULTS: At the time of maximal bleed-out, plasma corticosterone and corticotropin levels increased by 245% (P<.001) and 293% (P<.001), respectively. Despite corticotropin levels being similar to those of the animals undergoing sham operation after resuscitation, corticosterone levels in hemorrhaged animals remained elevated up to 4 hours after resuscitation (by 158%-207%; P<.001). In addition, corticotropin-induced corticosterone release decreased by 78% at 1.5 hours after resuscitation (P = .009). In contrast, moderate hypotension did not reduce corticotropin-induced corticosterone release. Adrenal corticosterone content and cAMP levels (i.e., the second messenger of corticotropin action) decreased by 55% (P<.001) and 25% (P = .03), respectively. Hepatic 11beta-HSD activity decreased significantly at 1.5 hours after resuscitation (P<.001). CONCLUSIONS: Sustained increase in plasma corticosterone levels following hemorrhage and resuscitation may be, in part, due to the decreased hepatic 11beta-HSD activity. The high level of corticosterone negatively regulates corticotropin release, further reducing adrenal responsiveness to corticotropin stimulation. Thus, the liver appears to play an important role in regulating adrenal function following trauma and severe hemorrhage.     

Cranial epidural empyema with osteomyelitis caused by actinomyces, CT, and MRI appearance

Actinomycosis is an uncommon cause of intracranial infection. Epidural empyema represents about 6% of CNS actinomycotic lesions. A case of an epidural empyema with parietal bone osteomyelitis caused by Actinomyces israelii is presented. Relevant neuroimaging features were bone erosions and a multiloculated collection with annular contrast enhancing on CT. Postoperative MRI revealed extensive involvement of the neighbor dura, falx, and subdural space. MRI was crucial to follow-up the response to antibiotic treatment.     

Epilepsy disclosing cancer of the kidney

Cerebral metastases of renal cell carcinoma are not rare, but metastasis which reveal the primary tumor are uncommon. The authors report a case of a 53-year-old woman who presented with renal cell carcinoma revealed by epileptic fit.     

腹腔镜手术与腹膜后大血管损伤

腹腔镜手术因其创伤小、患者痛苦少、术后恢复快等优点而在腹部盆腔疾病的诊断和治疗中得到广泛应用,但由其所引起的技术性并发症亦引起了腹腔镜医师的极大重视。我们仅对腹腔镜手术中腹膜后大血管损伤（ｍａｊｏｒｒｅｔｒｏｐｅｒｉｔｏｎｅａｌｖａｓｃｕｌａｒｉｎｊｕｒｙ,ＭＲＶＩ）作一简要综述。一、腹腔镜手术中ＭＲＶＩ的流行病学所谓腹腔镜手术中ＭＲＶＩ,是指在腹腔镜手术中使用穿刺针及穿刺套管暴力盲穿或器械操作不当而损伤腹主动脉、下腔静脉、门静脉、髂总动静脉及髂内外动静脉等腹膜后大血管,引起的一系列临床症状及…     

Clinical and epidemiological aspects of respiratory syncytial virus lower respiratory tract infections

This paper has analyzed respiratory syncytial virus lower respiratory tract infections in 201 hospitalized children. In children with wheezing, erythrocyte sedimentation rate (ESR) was significantly higher in those with pneumonia than with syndroma pertussis, while the white blood cell (WBC) count was significantly lower in patients with bronchitis than in those with bronchiolitis and syndroma pertussis. Bronchodilatators were applied in 75.6% and corticosteroids in 20% of patients. Ten patients were ventilated. Fatal disease outcome was observed in one infant. Twelve consecutive-year study of respiratory syncytial virus (RSV) infections showed that 27.3% of these diseases were bronchiolitis and pneumonia.     

More than just a health issue: a review of current issues in the care of enterally-fed children living in the community

There are increasing numbers of children with a disability living in the community who require enteral tube feeds to optimize their nutritional status. Whilst there appears to be evidence of health gains, for some children there may also be serious and unintended social deprivations resulting from the need to be tube fed. This paper reviews the literature on support for children who are tube fed and makes a case for more coordinated and effective support services for families who are tube feeding a child at home. It is argued that national guidance should be developed which clarifies the position of all non-parent carers and staff who are willing to administer enteral tube feeds. Such guidance should also ensure that enterally-fed children have the same rights to educational and social services as other children and that families are given the opportunity to make informed decisions about the implications of enteral feeding prior to it being established.     

Morphology of conjunctival progressive nevus

Structural features of 59 progressive nevuses of the conjunctiva were studied. The proliferation of the epithelium and melanocytes is partially compensated by spontaneous regression of the nevus structures. The growth of a nevus is structurally similar to tumor growth, but the nevuses lack the melanocyte dysplasia, the main sign of malignant degeneration. The immune reactions are involved in the tissue restructuring of the growing nevus. Permanent foci of photoelastosis reflect the significance of ultraviolet exposure as a factor of risk of the nevuses progress.     

Huge colloid cyst of the third ventricle associated with calcification in the cyst wall

Giant or huge colloid cysts of the third ventricle up to of more than 3 cm in diameter are extremely rare. The patient presented with symptoms of increased intracranial pressure, including headache, vomiting, and papilledema. Computerized tomographic (CT) scan revealed a hypodense, huge colloid cyst of the third ventricle associated with calcification in the cyst wall. Both hypodensity and calcification are uncommon roentgenological findings for colloid cysts of the third ventricle. The patient was operated on by the transcortical/transventricular approach and the colloid cyst was completely excised.