Methylprednisolone enhances contraction of porcine femoral head epiphyseal arteries

The pathomechanism of steroid-induced femoral head necrosis is thought to be disturbed femoral head blood flow. We hypothesize that methylprednisolone increases vasocontraction of femoral head epiphyseal arteries, thereby reducing femoral head blood flow. Nine immature female domestic pigs were randomly selected from a group of 18 to receive 24-hour methylprednisolone treatment, whereas the nine remaining pigs received the placebo control in a blinded fashion. After sacrifice, lateral epiphyseal artery segments from the femoral heads were mounted as ring preparations on a small vessel myograph. Isometric active tension was measured in relation to cumulating doses of the vasoconstrictors noradrenaline and endothelin-1, and the vasodilator bradykinin. Vasocontraction to noradrenaline was not altered by methylprednisolone. Bradykinin elicited a concentration-dependent vasodilation which was lower in the corticosteroid-treated vessels. Vasoconstriction to endothelin-1 was stronger in the corticosteroid-treated vessels. Our data indicate that methylprednisolone enhances contraction of femoral head lateral epiphyseal arteries and may decrease femoral head blood flow. To our knowledge, this pathomechanic factor in femoral head necrosis has not been described before.     

Thermal injury resulting from application of a granular mineral hemostatic agent

BACKGROUND: Uncontrolled hemorrhage accounts for the majority of deaths in combat. Effective topical hemostatic agents suitable for use on the battlefield may be valuable in controlling hemorrhage until definitive surgical intervention is possible. In an effort to identify a hemostatic agent suitable for battlefield use, we evaluated several potential hemostatic agents in a swine injury model and noted thermal injury to tissues with a granular mineral hemostatic agent (QuikClot). METHODS: Anesthetized swine were maintained with a mean arterial pressure in excess of 60 mm Hg. Cutaneous, muscular, hepatic, splenic, venous, and arterial wounds were created in a standardized fashion. Topical hemostatic agents were immediately applied to the wounds and the amount of bleeding and time to hemostasis were noted. RESULTS: The results reported here are part of a larger study in which a variety of hemostatic agents were evaluated. Only the findings related to the granular mineral hemostatic agent are discussed here. Application of the agent resulted in elevated tissue surface temperatures in excess of 95 degrees C and internal tissue temperatures exceeding 50 degrees C, 3 mm deep to the bleeding surface. Necrosis of fat and muscle were noted as well as full and partial thickness cutaneous burns. CONCLUSIONS: Topical administration of a granular mineral hemostatic agent to a variety of wounds in an experimental swine model resulted in thermal tissue injury and necrosis. Suggestions for reducing the extent of injury with this product are offered.     

Selection of patients for hand-assisted laparoscopic surgery

Each of the well-established approaches to laparoscopy-standard transperitoneal, standard retroperitoneal, and transperitoneal hand-assisted-has its advantages and disadvantages. In order to maximize efficiency and patient benefit, each approach should be used selectively. This paper offers recommendations for the selective use of the hand-assisted technique, which is particularly useful when intact specimen removal is required, the surgeon has limited experience, the situation is expected to be difficult (e.g., prior surgery, fibrosis, inflammation), or the patient's other medical comorbidities mandate a rapid procedure.     

Tracheal mucormycosis presented as an intraluminal soft tissue mass

BACKGROUND: Mucormycosis is a potentially lethal disease caused by an opportunistic fungal infection. It occurs mostly in diabetic or immunosuppressed patients and usually involves the lungs or paranasal sinuses. METHODS: We report a rare case of a patient with diabetic ketoacidosis who presented with progressive cough and dyspnea. CT of the neck and chest showed an intraluminal soft-tissue mass extending from the first tracheal ring to the thoracic inlet, causing severe destruction of the trachea. Direct laryngoscopy and biopsy demonstrated hyphal invasion with architecture typical of invasive mucormycosis. RESULTS: The patient underwent resection of the upper trachea and prolonged amphotericin B therapy and is disease free at 24 months after surgery. CONCLUSIONS: In patients with diabetes presenting with progressive hoarseness, dyspnea, and endobronchial mass, a fungal infection should be considered. In case of invasive tracheal mucormycosis, prompt diagnosis and early surgical resection may help improve survival.     

Identification of alternatively spliced human biotinidase mRNAs and putative localization of endogenous biotinidase

Biotinidase is essential for recycling the vitamin biotin and for transferring biotin to proteins, such as histones, suggesting that the enzyme localizes to various cellular and extracellular sites. To better understand the functions of the enzyme, we examined its gene structure and subcellular localization. Using RACE-PCR and a BLAST search, we extended the 5' sequence of the biotinidase gene. Three novel, alternatively spliced variants of biotinidase, 1a, 1b, and 1c, were identified in multiple human tissues. Exon 1c is present only in testes. The sequence of the 5' splice variants, 1a and 1b, suggest that biotinidase localizes to the mitochondria and/or ER, respectively. Using indirect immunofluorescence studies, biotinidase localizes to organelles in the cytoplasm, but not nucleus, of human fibroblasts and Hep G2 cells. Endogenous expression was examined by isopycnic gradient centrifugation of rat liver organelles, which identified an 85kDa biotinidase protein with biotinyl-hydrolase and transferase activities in microsomes and possibly lysosomes. A 48kDa protein, which also reacts with anti-biotinidase, localizes to mitochondria. The 48kDa protein is not N-glycosylated but is biotinylated, is in the inner mitochondrial matrix, but has no biotinyl-hydrolase or transferase activities. The function and validation of the mitochondrial species remains to be determined. The 5' splice variants and organelle fractionation studies indicate that biotinidase is directed to the secretory pathway and perhaps mitochondria.     

Chemokines: multiple levels of leukocyte migration control

The surge in interest in chemokines is explained by the recognition that numerous aspects of immunity are intimately related to leukocyte traffic. Chemokines are leukocyte attractants but also contribute to immune processes that do not directly involve leukocyte migration. Recent progress is most evident in the areas of lymphocyte development, immune response initiation and immune pathology. Important observations have also been reported on chemokine-receptor interactions, signal transduction and cellular responses. New insights into the role of chemokines in leukocyte attraction and relocation will be discussed, with emphasis on the distinct levels of leukocyte migration control that ultimately determine the performance of our immune defense system.