Surgical treatment of liver injuries by application of Fibrinkleber

The combination of highly concentrated fibrinogen, thrombin, clotting factor XIII, and fibrinolytic inhibitor aprotinin represents a new biological hemostatic, and adhesive system, known as Fibrinkleber. Liver injuries and injuries of parenchymatous organs, with the difficulties inherent in their surgical repair, are a suitable field of application for the new substance. In our experimental work, standardized sharp liver injuries in 29 rabbits were treated only by application of Fibrinkleber. In all cases, this procedure resulted in a complete control of bleeding as well as in a stable and lasting closure of wounds. Five of these animals died from causes unrelated to the liver trauma but rather to parasitosis. During the postoperative observation period, from 2 days to 2 months, microscopic and histological examination showed ideal repair of the glued wounds. In the control group, 5 rabbits were kept without application of Fibrinkleber. Three of the rabbits with liver injuries and all of the control group histological examinations showed separation of the wounds with minimal healing.

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Resumen Debido a su tamaño y ubicación, el hígado es un órgano muy vulnerable en casos de trauma abdominal. Las heridas hepáticas varían considerablemente y su severidad dépende del tipo y magnitud del trauma. En virtud de la vascularidad del hígado y, según la localización de la herida, el tratamiento del trauma hepático con frecuencia es difícil. La hemorragia resultante y los consiguientes complejos problemas postoperatorios significan un desafío formidable.La combinación de fibrinógeno altamente concentrado, trombina, factor XIII de coagulación y aproptinina, un inhibidor de fibrinolisis, ha venido a representar un nuevo sistema biológico hemostático y adhesivo, el cual se conoce como Fibrinkleber. Las lesiones hepáticas y en general las heridas de los órganos parenquimatosos, por las dificultades que presentan en el momento de la reparación quirúrgica, constituyen un campo propicio para la aplicación de esta nueva sustancia. En nuestro trabajo experimental se trataron heridas hepáticas estandarizadas en 29 conejos mediante la sóla aplicación de Fibrinkleber. Tal procedimiento resultó, en todos los casos, en un completo control del sangrado y en un cierre estable y duradero de las heridas por la firme adherencia de las superficies hepáticas. Cinco de los animales fallecieron por causas no relacionadas con el trauma hepático sino con parasitosis. En el curso del período de observación postoperatoria, desde el segundo día hasta dos meses, los exámenes microscópicos e histológicos mostraron una cicatrización ideal de las heridas así adheridas. En el grupo de control se incluyó a cinco conejos que no recibieron la aplicación de Fibrinkleber. Tres de estos perecieron poco tiempo después de infligida la lesión, y en todos el examen histológico demostró separación de la herida con mínima cicatrización.

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Résumé La combinaison à haute concentration de fibrinogène, de thrombine du facteur XIII et de l'aprotinine (inhibiteur de la fibrinolyse) permet de constituer un agent biologique d'hémostase et de coalescence dénommé Fibrinkleber. Les blessures du foie et plus généralement les blessures des organes parenchymateux dont la cure est difficile à assurer chirurgicalement sont susceptibles d'être traitées efficacement par cette nouvelle substance. A titre expérimental des blessures du foie identiques chez 29 lapins ont été traités uniquement par ce nouvel agent. Dans tous les cas l'hémorragie pu être arrêtée et la coalescence définitive de la plaie pu être obtenue. Cinq des 29 lapins moururent non de leur plaie hépatique mais de parasitose. Pendant la période d'observation postopératoire s'étendant du deuxième jour jusqu'à la fin du deuxième mois l'examen macroscopique et l'examen microscopique permirent de constater la cicatrisation parfaite de la plaie. Un groupe de contrôle comprenant cinq lapins qui présentaient une blessure hépatique de type identique mais traitée sans l'aide de l'agent coagulant et coalescent permit de constater que la plaie persistait et que sa cicatrisation était minime.

     

Chemotherapy of brain tumors

This is a review of chemotherapy options for patients with brain tumors, both at the time of initial diagnosis and at recurrence. Gliomas, the most common malignant brain tumors, represent the main focus of the review; chemotherapeutic options for supratentorial, brain stem, and optic track gliomas are discussed.     

Measles virus expressed Helicobacter pylori neutrophil-activating protein significantly enhances the immunogenicity of poor immunogens

Helicobacter pylori neutrophil-activating protein (NAP) is a toll-like receptor 2 (TLR2) agonist and potent immunomodulator inducing Th1-type immune response. Here we present data about characterization of the humoral immune response against NAP-tagged antigens, encoded by attenuated measles virus (MV) vector platform, in MV infection susceptible type I interferon receptor knockout and human CD46 transgenic (Ifnarko-CD46Ge) mice. Immunogenicity of MV expressing a full-length human immunoglobulin lambda light chain (MV-lambda) was compared to that of MV expressing lambda-NAP chimeric protein (MV-lambda-NAP). MV-lambda-NAP immunized Ifnarko-CD46Ge mice developed significantly higher (6–20-fold) anti-lambda ELISA titers as compared to the MV-lambda-immunized control animal group, indicating that covalently-linked NAP co-expression significantly enhanced lambda immunogenicity. In contrast, ELISA titers against MV antigens were not significantly different between the animals vaccinated with MV-lambda or MV-lambda-NAP. NAP-tagged antigen expression did not affect development of protective anti-measles immunity. Both MV-lambda and MV-lambda-NAP-immunized groups showed strong virus neutralization serum titers in plaque reduction microneutralization test. These results demonstrated that MV-encoded lambda-NAP is highly immunogenic as compared to the unmodified full-length lambda chain. Boost of immune response to poor immunogens using live vectors expressing NAP-tagged chimeric antigens is an attractive approach with potential application in immunoprophylaxis of infectious diseases and cancer immunotherapy.     

An observational study of sun and heat protection during Canada Day outdoor celebration, 2003

Attendance at summer outdoor mass gatherings may lead to heat- and sun-related illness. The purposes of this study were: (1) to estimate the proportion of people in attendance at the 2003 Canada Day celebration in the National Capital Region who used sun and heat protective items; (2) to identify factors associated with the utilization of these protective items; and (3) to provide research data to public outdoor event organizers when developing evidence-based plans for safer events. A naturalistic observational cross-sectional method was used to gather information at the 2003 Canada Day celebration in the National Capital Region on attendees' demographics, the sun and heat protective items they used and the protective resources available at the event sites. Of the 398 observed attendees, the proportion using any one of the protective items ranged from 3 percent (an open umbrella) to 51.5 percent (sunglasses). Females were more likely to use protective items more than males, and adults more likely than children. Planners of public outdoor events should consider the factors that influence the utilization of sun and heat protective behaviours and the environmental modifications that would allow participants to make safe choices.     

Incidental thyroid cancer in patients undergoing total thyroidectomy for benign disease

Aim

To determine the frequency of incidental thyroid carcinoma (ITC) in patients undergoing surgery for presumably benign thyroid diseases.

Methods

A total of 267 patients submitted to total thyroidectomy were included in the study.

Results

Histology revealed ITC in 31 (11.6%) patients. Papillary carcinoma was the commonest ITC at a percentage of 71% (22/31 patients), while follicular variant accounted for 29%. ITC was more common in patients with toxic goitre and toxic solitary nodule.

Conclusions

The result of this study show a high incidence of ITC (11.6 %). The frequency differs among patients presenting a different thyroid pathology. This is because of the small sample used in the study. Papillary carcinoma was the commonest ITC.

     

Detection of Tract Formation for Prevention of Bile Peritonitis after T-Tube Removal. Case Report

Bile leakage after removal of T-tube is a relatively rare complication caused by inadequate tract formation around the tube. We report a case of bile peritonitis after removal of a latex T-tube. The patient underwent reoperation and a new T-tube was introduced. The T-tube was removed six weeks later. Immediately after removal of the tube, the cutaneous ostium of the tube was catheterized with a thin Nelaton catheter. The administration of gastrographin showed the presence of an intact tract. The removal of the t-tube was uneventful. We would propose this method for detecting the tract after removal of the T-tube in order to prevent severe bile leakage after inadequate tract formation.     

Circulating angiogenic biomolecules at rest and in response to upper-limb exercise in individuals with spinal cord injury

Objective

Individuals with spinal cord injury (SCI) show structural and functional vascular maladaptations and muscle loss in their lower limbs. Angiogenic biomolecules play important roles in physiological and pathological angiogenesis, and are implicated in the maintenance of muscle mass. This study examined the responses of angiogenic molecules during upper-limb aerobic exercise in patients with SCI and in able-bodied (AB) individuals.

Methods

Eight SCI patients with thoracic lesions (T₆–T₁₂, ASIA A) and eight AB individuals performed an arm-cranking exercise for 30 minutes at 60% of their VO_2max. Plasma concentrations of vascular endothelial growth factor (VEGF-A₁₆₅), VEGF receptor 1 (sVEGFr-1), VEGF receptor 2 (sVEGFr-2), metalloproteinase 2 (MMP-2), and endostatin were measured at rest, after exercise, and at 1.5 and 3.0 hours during recovery.

Results

The two-way analysis of variance showed non-significant main effects of “group” and significant main effects of “time/exercise” for all angiogenic biomolecules examined (P < 0.01–0.001). The arm-cranking exercise significantly increased plasma concentrations of VEGF, sVEGFr-1, sVEGFr-2, MMP-2, and endostatin in both groups (P < 0.001–0.01). The magnitude of the increase was similar in both patients with SCI and AB individuals, as shown by the non-significant group × time interaction for all angiogenic parameters.

Conclusions

Upper-limb exercise (arm-cranking for 30 minutes at 60% of VO_2max) is a sufficient stimulus to trigger a coordinated circulating angiogenic response in patients with SCI. The response of angiogenic molecules to upper-limb aerobic exercise in SCI appears relatively similar to that observed in AB individuals.     

Endoscopic sphincterotomy in patients with "acalculus" cholangitis associated with juxtapapillary diverticula

BACKGROUND/AIMS: The aim of this study was to investigate patients who underwent endoscopic sphincterotomy for "acalculus" cholangitis associated with juxtapapillary diverticula. METHODOLOGY: In a retrospective study we analyzed 87 patients who underwent endoscopic sphincterotomy for cholangitis; the cholangitis considered "acalculus", when outlining the extra- and intrahepatic bile ducts, we could not observe any intraluminal defect or stricture, and during the clearing of the bile ducts with the balloon, after endoscopic sphincterotomy, there was no evidence of stones, fragments of stones or sludge. Patients who had undergone previous endoscopic sphincterotomy, or who had additional pancreatobiliary diseases were excluded from this study. There were 11 patients with "acalculus" cholangitis associated with juxtapapillary diverticula, and sufficient clinical data available for this study. RESULTS: Nine patients presented pain, fever, and jaundice. In two patients diagnosis was established via the test of abnormal liver biochemistry. Seven patients had positive blood cultures and three of them developed confusion and hypotension. Endoscopic sphincterotomy succeeded in all cases; no evidence of stones, fragments of stones or sludge was recorded during the clearing of bile ducts, after endoscopic sphincterotomy, with the balloon. Five patients presented mild post-endoscopic sphincterotomy complications successfully treated. In the follow-up period, from 4 months to 7 years after endoscopic sphincterotomy, none of the patients developed symptoms of cholangitis. CONCLUSIONS: We recommend endoscopic sphincterotomy in patients with "acalculus" cholangitis associated with juxtapapillary diverticula, despite the absence of obvious obstruction, and the possible morbidity which is inherent with an invasive procedure like endoscopic sphincterotomy.     

Essential role of brain-derived neurotrophic factor in adult hippocampal function

Brain-derived neurotrophic factor (BDNF) regulates neuronal development and function. However, it has been difficult to discern its role in the adult brain in influencing complex behavior. Here, we use a recently developed inducible knockout system to show that deleting BDNF in broad forebrain regions of adult mice impairs hippocampal-dependent learning and long-term potentiation. We use the inducible nature of this system to show that the loss of BDNF during earlier stages of development causes hyperactivity and more pronounced hippocampal-dependent learning deficits. We also demonstrate that the loss of forebrain BDNF attenuates the actions of desipramine, an antidepressant, in the forced swim test, suggesting the involvement of BDNF in antidepressant efficacy. These results establish roles for BDNF in the adult, and demonstrate the strength of this inducible knockout system in studying gene function in the adult brain.