Subacute posttraumatic ascending myelopathy (SPAM): A potential complication of subarachnoid shunt for syringomyelia?

Context: Treatment of primary spinal syringomyelia is still controversial. Among others, shunting syrinx fluid to the subarachnoid, peritoneal or pleural space has been utilized with varying success. Shunt obstruction, migration, and infection represent the most common complications of these procedures.

Findings: The authors present the case of an 81-year-old woman who developed an unusual neurological deterioration resembling a subacute posttraumatic ascending myelopathy (SPAM) after the insertion of a syringosubarachnoid shunt for the treatment of slow-growing D10 syringomyelia.

Conclusion/Clinical Relevance: To date, no cases of SPAM secondary to the insertion of a syringosubarachnoid shunt for the treatment of syringomyelia have been reported. The potential pathogenesis related to this phenomenon is discussed.     

复合带瓣人工血管替换升主动脉和主动脉瓣(24例报告)

报告２４例升主动脉瘤伴主动脉瓣关闭不全行升主动脉和主动脉瓣替换及冠状动脉开口移植术（Ｂｅｎｔａｌ术２２例，底盘法２例）。１３例伴有升主动脉夹层分离，对其中８例ＤｅＢａｋｅｙＩ型者，以Ｔｅｆｌｏｎ毡条内外加固主动脉切端后吻合。１３例用人工血管周围间隙与右心耳吻合以控制升主动脉吻合之外的出血。３例以人工血管片环包主动脉吻合口控制局部广泛渗血及出血。２例术毕不能脱离体外循环死亡，手术死亡率８３％。随访平均２１８个月，２例死于蛛网膜下腔出血，１例右股动脉栓塞经手术治愈；其余病人康复良好，心功能（ＮＹＨＡ）Ｉ～ＩＩ级。     

Effect of the NK3 receptor antagonist, talnetant, on rectal sensory function and compliance in healthy humans

Visceral hypersensitivity is important in the pathophysiology of irritable bowel syndrome and thus a target for modulation in drug development. Neurokinin (NK) receptors, including NK(3) receptors, are expressed in the motor and sensory systems of the digestive tract. The aim of this study was to compare the effects of two different doses (25 and 100 mg) of the NK(3) receptor antagonist, talnetant (SB223412) with placebo on rectal sensory function and compliance in healthy volunteers studied at two centres. Rectal barostat tests were performed on 102 healthy volunteers, randomized to receive either oral talnetant 25 or 100 mg or placebo over 14-17 days. Studies were performed on three occasions: day 1 immediately prior to 1st dose, day 1 4 h postdose, and after 14- to17-day therapy. Compliance, and pressure thresholds for first sensation, urgency, discomfort and pain were measured using ascending method of limits, and sensory intensity ratings for gas, urgency, discomfort and pain determined during four random phasic distensions (12, 24, 36 and 48 mmHg). Talnetant had no effect on rectal compliance, sensory thresholds or intensity ratings compared with placebo. In general, the results obtained at the two centres differed minimally, with intensity scores at one centre consistently somewhat lower. At the doses tested, talnetant has no effect on rectal compliance or distension-induced rectal sensation in healthy participants.     

Vasopressin stimulation of NaCl transport in the medullary thick ascending limb of Henle's loop is decreased in aging mice

The maximal urinary osmolality that can be reached by the kidney is reduced with age. This may be due to impaired NaCl transport by the medullary thick ascending limb of Henle's loop, which is part of the renal concentrating mechanism and is modulated by antidiuretic hormone (ADH). We therefore tested in vitro a possible age-related change in the transport capacity and in the response of this nephron segment to ADH in young (1–2 months) and old (20–24 months) mice. The transepithelial potential difference (V _te) was significantly higher in young mice (+8.5±0.4 mV, n=13) than in old ones (+6.6±0.5 mV, n=17). Addition of 0.1 nmol.l^–1 ADH to the bath solution significantly increased V _te by 5.2±0.5 mV in the young and by 3.1±0.6 mV in the old animals. Application of dibutyryl-cAMP (0.1 mmol.1^–1) did not further increase the hormonal response in both groups. The ADH-mediated increase in the corresponding equivalent short-circuit current (I _SC = V _te/R_te) was twice as great in young mice as in old, indicating that the stimulation of NaCl transport by ADH across the medullary thick ascending limb is significantly reduced with age. These results suggest that the previously reported age-related defect in the urinary concentrating ability of the kidney is partly due to a decreased response of the medullary thick ascending limb to ADH.     

猪升主动脉几何形态与显微结构的增龄性变化

目的:探讨猪升主动脉几何形态与显微结构成分在增龄过程中的变化规律,为猪→人异种心脏移植吻合血管提供必要的形态学基础。方法:应用组织学和计算机图像分析方法,对42例1～7月龄猪升主动脉进行计量形态学研究。结果:猪升主动脉的管径、壁厚、管腔面积、管壁面积与月龄间呈高度直线正相关关系(r分别为0.98、0.98、0.99、0.99,各P值均<0.001),它们分别以1.54mm月、0.15mm/月、28.26mm~2/月和12.28mm~2/月的速率增加。管壁中胶原纤维含量随之增加(P<0.05);弹性纤维含量以2、3月龄最高,而后维持在相对恒定水平,平滑肌的含量在增龄过程中未见明显变化(P>0.05)。结论:与人类相似,猪升主动脉几何形态、显微结构成分含量与年龄密切相关。     

尺动脉腕背支升支皮瓣的应用解剖学研究

目的　为临床应用尺动脉腕背支升支皮瓣修复手部创面 ,提高治疗效果提供解剖学基础。方法　用新鲜成人男性上肢标本 1 6侧 ,采用显微解剖学技术 ,对尺动脉腕背支升支的起始、走行、分支及分布进行解剖学观察和测量。结果　尺动脉腕背支起始于尺动脉的尺侧 ,距豌豆骨上方 4 2 .6 0± 8.2 0mm ,起始处外径1 .4 6± 0 .32mm ,长 1 1 .4 6± 8.2 0mm。尺动脉腕背支与尺神经手背支伴行 ,穿过尺侧腕屈肌腱的深面 ,从掌侧向后内侧斜行 ,两者成锐角 ,平均 38.6 0± 8.2 0°,行至 1 1 .4 6mm处分为升支与降支。升支穿深筋膜进入皮下组织 ,沿前臂内侧缘上行 1 2 2 .4 0± 1 3.80mm处再分为细小分支 ,升支起始部的外径为 0 .6 2± 0 .2 8mm。结论　尺动脉腕背支升支皮瓣是以尺动脉腕背支升支为蒂 ,可在前臂尺侧设计大面积岛状皮瓣 ,通过转位修复腕部和手部创伤及挛缩瘢痕切除术后的创面 ,不牺牲前臂主要血管 ,手术操作易于掌握     

Fluorescent retrograde triple labeling of brainstem reticular neurons

The present study was aimed at the anatomical identification in the rat of neurons of the lower brainstem reticular formation which give off axonal branches ascending bilaterally to more rostral structures and descending unilaterally to the spinal cord. Three fluorescent tracers were injected in one and the same animal. Fast Blue was injected in the midbrain tegmentum, in the termination areas and fiber bundles of the ascending reticular efferents; Evans blue was injected in the midbrain tegmentum on the other side; either Nuclear Yellow or Diamidino Yellow was injected in the white and gray matter of the upper cervical cord. All three populations of single-labeled cells, as well as double labeled either from the midbrain injections or from the ipsilateral injections in the mesencephalon and spinal cord, were intermingled in the medial reticular formation. Very few cells double labeled from the contralateral mesencephalon and ipsilateral spinal cord were also seen. However, the main finding of the present study was the visualization of triple-labeled cells. The latter were mainly located ipsilaterally to the injections in the spinal cord. The present results indicate that reticular cells give off divergent multiple branches descending to the ipsilateral spinal cord and ascending bilaterally to rostral centers.     

Effects of parathyroid hormone and calcitonin on Na+, Cl−, K+, Mg2+ and Ca2+ transport in cortical and medullary thick ascending limbs of mouse kidney

The effect of parathyroid hormone (PTH) on transepithelial Na⁺, Cl^–, K⁺, Ca²⁺ and Mg²⁺ transport was investigated in isolated perfused cortical thick ascending limbs (cTAL) and that of human calcitonin (hCT) was tested in both cortical and medullary thick ascending limbs (mTAL) of the mouse nephron. The transepithelial ion net fluxes (J _x) were determined by electron probe analysis of the perfused and collected fluids. Simultaneously, the transepithelial voltage (PD_te) and resistance (R _te) were recorded. In cTAL segments, PTH and hCT significantly stimulated the reabsorption of Na⁺, Cl^–, Ca²⁺ and Mg²⁺. hCT generated a net K⁺ secretion towards the lumen and PTH tended to exert the same effect. Neither PD_te nor R _te were significantly altered by either PTH or hCT. However, in the post-experimental period a significant decrease in PD_te was noted. Time control experiments carried out under similar conditions revealed a significant decrease in PD_te with time, which could have masked the hormonal response. In mTAL segments, Mg²⁺ and Ca²⁺ transport was close to zero. hCT did not exert any detectable effect on either PD_te or J _Cl ^–, J _Na ⁺ J _K ⁺, J _Mg ²⁺ and J _Ca ²⁺ in these segments. In conclusion, our data demonstrate that PTH and hCT stimulate NaCl reabsorption as well as Mg²⁺ and Ca²⁺ reabsorption in the cTAL segment of the mouse. These data are in agreement with and extend data obtained in vivo in the rat.     

Primary malignant fibrous histiocytoma of the ascending colon: Report of a case

We report herein an unusual case of primary malignant fibrous histiocytoma (MFH) of the ascending colon. A 47-year-old man was admitted to our hospital for further investigations following the discovery of a mass in the right lower quadrant of the abdomen during a medical checkup. Abdominal ultrasonography (US) and computed tomography (CT) demonstrated a mass extending to the right lateral side from the ascending colon. At laparotomy, a tumor was found originating in the ascending colon and infiltrating the right lateral peritoneum. A right hemicolectomy and partial peritoneal dissection were performed followed by an ileotransverse colostomy reconstruction. The resected specimen contained a tumor measuring 7×5×4 cm, the cut surface of which was yellowish white, and the mucosa of the colon was intact. Based on histological and immunohistochemical inspection, the tumor was diagnosed as MFH of the ascending colon. We reviewed the total 18 known cases of colorectal MFH documented in the literature including our case. After surgery, 4 of 17 patients died of local recurrence, all within 42 months, indicating that early and complete excision of tumor is essential to achieve cure.