TIPSS for variceal hemorrhage after living related liver transplantation： A dangerous indication

The introduction of transjugular intrahepatic portal-systemic stent-shunt(TIPSS)has been a majorbreakthrough in the treatment of portal hypertension,which has evolved to a large extent,into a routineprocedure.A 21-year-old male patient with progressivegraft fibrosis/cirrhosis requiring TIPSS for varicealhemorrhage in the esophagus due to portal hypertensionwas unresponsive to conventional measures twoyears after living related liver transplantation(LDLT).Subsequently,variceal hemorrhage was controlled,however,liver function decreased dramatically withconsecutive multi organ failure.CT scan revealedsubstantial necrosis in the liver.The patient underwentsuccessful"high urgent"cadaveric liver transplantationand was discharged on postoperative d 20 in a stablecondition.     

Walking from thought

Online analysis and classification of single electroencephalogram (EEG) trials during motor imagery were used for navigation in the virtual environment (VE). The EEG was recorded bipolarly with electrode placement over the hand and foot representation areas. The aim of the study was to demonstrate for the first time that it is possible to move through a virtual street without muscular activity when the participant only imagines feet movements. This is achieved by exploiting a brain-computer interface (BCI) which transforms thought-modulated EEG signals into an output signal that controls events within the VE. The experiments were carried out in an immersive projection environment, commonly referred to as a "Cave" (Cruz-Neira, C., Sandin, D.J., DeFanti, T.A., Surround-screen projection-based virtual reality: the design and implementation of the CAVE. Proceedings of the 20th annual conference on Computer graphics and interactive techniques, ACM Press, 1993, pp. 135-142) where participants were able to move through a virtual street by foot imagery only. Prior to the final experiments in the Cave, the participants underwent an extensive BCI training.     

Rotundum psoas hitch: a new method for colpohysteropexy in girls with bladder exstrophy

Female patients with bladder exstrophy frequently suffer from uterine prolapse, which is due to a defective pelvic floor anatomy. Different techniques for the correction of procidentia in this patient population have been described; however, since the numbers of patients are very small and no series with long-term follow-up exists, it is unclear which technique yields superior results. We describe here a new technique for uteropexy in girls and women with bladder exstrophy. In the rotundum psoas hitch procedure (RPH), the round ligaments are detached from the inner inguinal ring and fixed to the psoas muscle on both sides, thereby fixing the uterus in a more cranial and dorsal position. This procedure has been applied successfully in nine patients with a mean follow-up of 23.8 months. In six cases RPH was done prophylactically and in three cases therapeutically to correct an existing uterine prolapse. The mean age at operation was 9.6 years. In all but one case, RPH was combined with continent urinary reconstruction. No postoperative morbidity due to this technique has been described. RPH is an effective means of preventing or correcting procidentia in patients with bladder exstrophy; we emphasize that it should be combined with other abdominal operations, such as continent reconstruction, in girls or women with this condition.     

Pulmonary aspiration: new therapeutic approaches in the experimental model

BACKGROUND: Acute lung injury caused by gastric aspiration is a frequent occurrence in unconscious patients. Acute respiratory distress syndrome in association with gastric aspiration carries a mortality of up to 30% and accounts for up to 20% of deaths associated with anesthesia. Although the clinical condition is well known, knowledge about the exact inflammatory mechanisms is still incomplete. This study was performed to define the role of alveolar macrophages in this inflammatory response. In addition, potentially modifying effects of intratracheally applied nuclear factor kappaB inhibitor pyrrolidine dithiocarbamate were investigated. METHODS: Rat alveolar macrophages were depleted by intratracheal administration of clodronate liposomes, and lung injury was evaluated 6 h after instillation of 0.1N hydrochloric acid. In a second set of experiments, pyrrolidine dithiocarbamate was intratracheally instilled 3 h after hydrochloric acid application, and injury parameters were determined. RESULTS: Depletion of alveolar macrophages resulted in decreased production of inflammatory mediators in acid aspiration (23-80% reduction of messenger RNA or protein of inflammatory mediators; P < 0.05) and consequently also in diminished neutrophil recruitment (36% fewer neutrophils; P < 0.01). Treatment with pyrrolidine dithiocarbamate was highly effective in decreasing neutrophil recruitment (66%; P < 0.01) and vascular permeability (80%; P < 0.001). CONCLUSIONS: These data suggest that alveolar macrophages play an essential role in the inflammatory response of acid-induced lung injury. For the first time, attenuation of acid-induced lung injury with an inhibitor, applied after the onset of injury, is shown.     

Preservation of vascular contraction during ageing: dual effect on calcium handling and sensitization

(1) The present study was aimed to characterize the effects of ageing on vascular contraction by noradrenaline in rat isolated arteries. The existence of vascular bed heterogeneity was investigated in endothelium-denuded conductance (aorta) and resistance (small mesenteric artery, SMA) arteries, with respect to Ca(2+) handling, Ca(2+) sensitization or Ca(2+)-independent mechanisms. (2) In both arteries, contractions to noradrenaline were not different between adult and aged rats. (3) In Ca(2+)- free medium, noradrenaline elicited a transient increase in tension that was reduced by the Ca(2+) mobilizing agents, ryanodine and thapsigargin, in arteries from adult rats. A loss of the thapsigargin- but not the ryanodine-sensitive component of noradrenaline-induced contraction was observed in the two arteries from aged rats. (4) After depletion of Ca(2+) stores with noradrenaline, addition of exogenous CaCl(2) produced a sustained contraction that was decreased to the same extent by the protein kinase C inhibitor, GF 109203X and the tyrosine kinase inhibitor, tyrphostin A-23, in arteries from adult and aged rats. The Rho-associated protein kinase inhibitor, Y-27632, caused identical relaxation of noradrenaline pre-contracted arteries from both age groups. (5) Basal intracellular calcium ([Ca(2+)](i)) was higher in SMA from aged than from adult rats. In addition, the noradrenaline [Ca(2+)](i)-force relationship was significantly shifted to the right in the SMA from aged rats. (6) Altogether, these data indicate that responsiveness to noradrenaline is preserved both in conductance and resistance arteries with ageing. The latter results from the association of increased basal [Ca(2+)](i), changes in Ca(2+) handling at the level of thapsigargin-sensitive sarcoplasmic reticulum Ca(2+)-ATPases and decreased myofilament sensitivity to Ca(2+).     

Beta-amyloid precursor protein staining of nonaccidental central nervous system injury in pediatric autopsies

Immunohistochemical staining for beta-amyloid precursor protein (betaAPP) is a well-established marker of traumatic axonal injury in adults. Recent studies have used similar techniques to evaluate nonaccidental central nervous system injury (NAI) in infants and young children. In this prospective study, we report the results of betaAPP immunohistochemistry on the brain and spinal cord in 28 pediatric cases of NAI. BetaAPP-immunoreactive axons were present in 27/28 cases. Vascular axonal injury (VAI) due to brain swelling and secondary vascular compromise was the most common pattern of betaAPP immunoreactivity and was detected in 22 of 28 cases. Traumatic axonal injury was detected in 19/28 cases, although only eight of these cases showed brainstem staining, thus fulfilling the criteria for the diagnosis of diffuse traumatic axonal injury (dTAI). TAI and VAI were both present in 16/28 cases. Isolated TAI and VAI occurred in three and five cases, respectively. All children with isolated VAI were <18 months of age. An additional finding highlighted by betaAPP immunostaining was a penumbra of axonal injury adjacent to focal lesions, such as lacerations. We conclude that betaAPP immunohistochemistry aids in documenting trauma in nonaccidental central nervous system injury in infants and young children and that VAI is a common finding.