Hepatic infarction with absolute ethanol

Ethanol was used to embolize the hepatic artery in 7 dogs, producing occlusion proportional to the dose employed. On follow-up angiography at 1 and 4 weeks, occlusion was unchanged or more pronounced, indicating that such embolization is permanent. Because ethanol is nonviscous and easy to use, it is effective in occluding the hepatic arterial system. Perisinusoidal fibrosis is produced.     

Lymphatic sinusoids exist in chick but not in rabbit choroid

Purpose: Although it is generally thought that lymphatics do not exist in the choroid, there is mounting evidence that lymphatic-like structures do exist in primates and fowl. Methods/Results: Our comparison of the ultrastructure of chick and rabbit outer choroid indicates that major differences exist in the non-vascular areas of the choroid: notably, the chick has large lymphatic sinusoids, whereas the rabbit only has a system of large vacuoles contained within the processes of individual fibroblasts. Conclusions: These results raise questions regarding the similarities or otherwise between species of the management of retinal metabolites, excess tissue fluid and choroidal homeostasis, especially during conditions of overload.     

Neurogenic flare responses following topical application of capsaicin in humans

The flare response to noxious stimulation of the skin is mediated by polymodal nociceptors of C fiber primary afferent nerves. Topical application of capsaicin initiates a flare response and burning pain. In this study, the variability of capsaicin-induced flare and pain was assessed in 220 subjects. The major factors in flare response are body site and age; more severe reactions occur in more proximal sites and in younger subjects. Larger flares were shown to be associated with greater pain. Variability is probably due to differences in the structure and reactivity of the neurovascular unit as proposed in the Lewis model of the axon reflex. It may prove possible to assess polymodal nociceptor function using topical capsaicin in disease states that affect the peripheral terminals of primary afferent nerves.     

Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach

Summary This report describes a laparoscopic procedure for prosthetic repair of inguinal hernias using an extraperitoneal approach. A total of 51 primary direct and indirect hernias were repaired in this series, including 11 recurrent and 12 bilateral hernias. Operative time for this laparoscopic procedure was similar to that of the comparable open surgery and no unusual complications were noted. All patients were discharged the day following surgery and returned to work within 7 days.     

Acute pancreatitis: prognostic value of CT

In 83 patients with acute pancreatitis, the initial computed tomographic (CT) examinations were classified by degree of disease severity (grades A-E) and were correlated with the clinical follow-up, objective prognostic signs, and complications and death. The length of hospitalization correlated well with the severity of the initial CT findings. Abscesses occurred in 21.6% of the entire group, compared with 60.0% of grade E patients. Pleural effusions were also more common in grade E patients. Grades A and B patients did not have abscesses, and none died, regardless of the number of prognostic signs. Abscesses were seen in 80.0% of patients with six to eight prognostic signs, compared with 12.5% of those with zero to two. The use of prognostic signs with initial CT findings results in improved prognostic accuracy. Early CT examination of patients with acute pancreatitis is a useful prognostic indicator of morbidity and mortality.     

OESOPHAGEAL FOREIGN BODY PRESENTING WITH PARADOXICAL RESPIRATORY SYMPTOMS

SUMMARY Two cases are described of oesophageal foreign body impaction presenting with respiratory symptoms.     

Carotenoid compound crocetin improves cerebral oxygenation in hemorrhaged rats

The carotenoid compound crocetin has been shown to increase oxygen diffusivity in vitro. In the present study the effect of crocetin on tissue oxygenation was examined in the cerebral cortex of rats subjected to hemorrhage. Twelve male Sprague-Dawley rats were anesthetized with pentobarbital and ventilation was controlled (PaCO2 = 33 mm Hg). A craniotomy was performed and the animals were hemorrhaged (20% of estimated total blood volume). Six of 12 animals then received a bolus of crocetin (2 U in 0.1 ml saline); the remaining animals received saline (0.1 ml i.v.) only. Values for mean arterial pressure. PO2, PCO2, pH, and hematocrit did not differ in rats that received either saline or crocetin. Tissue oxygen tension (PtO2) was measured at approximately 170 locations in the parietal cerebral cortex of each rat by a platinum-oxygen microelectrode technique. Results were compared by PtO2 frequency histograms. Crocetin as compared with saline treatment resulted in a right shift of the PtO2 frequency distribution and a significant decrease in the frequency of occurrence of low PtO2 values. The average of individual median PtO2 values was significantly greater in crocetin-treated animals as compared with those receiving saline (7.6 +/- 1.7 vs. 3.2 +/- 1.2 mm Hg, respectively). The results suggest that the carotenoid compound crocetin improves tissue oxygenation in the cerebral cortex of hemorrhaged rats.     

Magnetic resonance cholangiopancreatography

Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive imaging method for examining the biliary and pancreatic ducts. The technique uses heavily T2-weighted imaging, which produces high signal from bile and other static fluids by virtue of their long T2 time, while suppressing background signal. Fast scanning techniques, particularly half-Fourier fast spin-echo techniques, are continuing to improve image resolution and allow scans within short breath-holds, reducing the effects of respiratory movement. The MRCP method has reached a level of resolution and reliability where it may well largely replace diagnostic endoscopic retrograde cholangiopancreatography (ERCP) in the near future. A review of MRCP techniques and imaging findings is presented with emphasis on half-Fourier imaging, with reference to potential clinical indications and limitations. Use of MRCP shows a high sensitivity and specificity for detection of biliary dilatation, calculi, strictures and anatomical variants. Experience with MR imaging of the pancreatic duct is less extensively described in the literature, but pancreatic duct dilatation, calculi and anatomy can now be reliably detected. However, as experience with MRCP increases, some sources of errors and limitations are becoming apparent, with image artefacts, and gas, blood or sludge within ducts potentially mimicking stones or strictures.