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Int J Dermatol. 2002 Mar;41(3):166-7.
Pathergic pyoderma gangrenosum in a venous ulcer.
Rosina P, Cunego S, Franz CZ, D'Onghia FS, Chieregato G.
Section of Dermatology and Venereology, Department of Biomedical and Surgical Science, University of Verona, Italy.
A 74-year-old woman was referred to our department in December 1999 for a pyoderma gangrenosum (PG) arising at the edges of chronic leg ulcer. The history was positive for benign monoclonal gammopathy, ischemic hypertensive cardiopathy, polyarthrosis and venous lower leg deficiency. Monoclonal gammopathy of IgA Kappa type was diagnosed 10 years before with a continued benign nature. In 1990 a post traumatic PG of the left leg was diagnosed and a therapy with Cyclosporine A was started with healing of the lesion. In June 1999, 6 months before the hospitalization, a typical venous ulcer of the right leg appeared and was treated with bed-rest, compression bandaging and topical desloughing therapy. In the last month, after a minor surgical debridement of the wound, the lesion developed pustules evolving into a painful, necrotic ulcer with ragged, purple-red, undetermined borders (Fig. 1). A relapse of PG was suspected. Histological examination was consistent with pyoderma gangrenosum and showed massive neutrophilic infiltration, hemorrhage and necrosis of the overlying epidermis. Wound culture was negative. Other laboratory examinations only showed IgA = 8.15 g/L. Investigation of other underlying medical conditions were normal or negative. The venous leg ulcer gradually healed with antiseptic and compression-bandage therapy. After a 4-month course of topical steroid therapy with good results, the PG recurred also involving the proximal area of the leg. Methylprednisolone 50 mg/day was started. Healing began 10 days later and 2 months later the wound healed and epithelialized. Steroid was reduce to 5 mg daily for 4 months. No recurrence was seen when the drug was stopped.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12010342&dopt=Abstract hemorrhage
Ren Fail. 2002 Nov;24(6):849-52.
Postpartum hemorrhage complicated with irreversible renal failure and central diabetes insipidus.
Wang HY, Chang CT, Wu MS.
Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.
Sheehan's syndrome is a rare complication of pregnancy with multiple hormone deficiency. The exact pathogenetic mechanism is not well understood, because such endocrine abnormalities are not obvious in most women with severe hemorrhage. Central diabetes insipidus with fluid and sodium disturbances occurred in about 5% of the patients. [1,2] There are very few existing literature discussing concomitant Sheehan's syndrome and acute renal failure. The following case reports a patient showing Sheehan's syndrome, irreversible acute renal failure and central diabetes insipidus concurrently.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12472206&dopt=Abstract hemorrhage
Eur J Med Res. 2002 Apr 30;7(4):139-48.
Calculation is unsuitable for determination of O2-consumption (VO2) in case of O2-supply-dependency.
Kemming GI, Meisner FG, Kleen M, Habler OP.
Institute for Surgical Research and Clinic of Anesthesiology, Klinikum Grosshadem, Ludwig-Maximilians-University Munich, Germany. gregor.kemmincf.med.uni-muenchen.de
BACKGROUND: When O2-delivery to tissues is critically reduced, O2-consumption becomes dependent on O2-delivery and starts to decline, which reflects tissue hypoxia. In order to timely detect tissue hypoxia prior to organ damage, O2-consumption may be calculated or measured from respiratory gases. We have assessed reproducibility of calculated and measured O2-consumption-data and their agreement during O2-supply-dependency. METHOD: Data of 31 anesthetized, ventilated pigs were analysed retrospectively. Animals had undergone either controlled hemorrhage ("shock") or isovolemic exchange of blood with colloids (extreme hemodilution, "HD") until O2-consumption had become dependent on O2-delivery. O2-consumption was calculated from the Fick equation and measured simultaneously with a DELTATRAC II metabolic monitor. Repeatability was determined for (1) calculated and (2) for measured.VO2 -values and (3) for input variables of the Fick equation (i.e. cardiac index (CI) and arteriovenous O2-content difference (CaO2-CvO2)). Bias between calculated and measured data and precision of calculation were assessed from paired O2-consumption-values obtained before and after induction of O2-supply-dependency via hemorrhage or extreme hemodilution. RESULTS: Repeatability of the reversed Fick method was inferior to repeatability of measurement (27 vs 15%) due to error propagation from CI and (CaO2-CvO2). Between-method-bias at baseline ("BL") was 3%, and changed in case of O2-supply-dependency (shock -15%; HD -31%, both p<0.05 vs BL), precision of the reversed Fick method deteriorated (BL 32%; shock 60%; HD 60%) due to variability of CI (CV: 16%; shock 27%; HD 41%). CONCLUSION: In anesthetized pigs calculated and measured O2-consumption values are in agreement, while in presence of O2-supply-dependency the reversed Fick method (1) grossly underestimates true O2-consumption and (2) precision deteriorates not allowing to verify or reject the presence of tissue hypoxia.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12010648&dopt=Abstract hemorrhage
Blood. 2002 Jun 1;99(11):4160-5.
Neutrophil activation by heme: implications for inflammatory processes.
Graca-Souza AV, Arruda MA, de Freitas MS, Barja-Fidalgo C, Oliveira PL.
Departamento de Farmacologia, Instituto de Biologia, Universidade do Estado do Rio de Janeiro, Brazil. avsouzioqmed.ufrj.br
Heme, a ubiquitous iron-containing compound, is present in large amounts in many cells and is inherently dangerous, particularly when it escapes from intracellular sites. The release of heme from damaged cells and tissues is supposed to be higher in diseases such as malaria and hemolytic anemia or in trauma and hemorrhage. We investigated here the role of free ferriprotoporphyrin IX (hemin) as a proinflammatory molecule, with particular attention to its ability to activate neutrophil responses. Injecting hemin into the rat pleural cavity resulted in a dose-dependent migration of neutrophils, indicating that hemin is able to promote the recruitment of these cells in vivo. In vitro, hemin induced human neutrophil chemotaxis and cytoskeleton reorganization, as revealed by the increase of neutrophil actin polymerization. Exposure of human neutrophils to 3 microM hemin activated the expression of the chemokine interleukin-8, as demonstrated by quantitative reverse-transcription polymerase chain reaction, indicating a putative molecular mechanism by which hemin induces chemotaxis in vivo. Brief incubation of human neutrophils with micromolar concentrations of hemin (1-20 microM) triggered the oxidative burst, and the production of reactive oxygen species was directly proportional to the concentration of hemin added to the cells. Finally, we observed that human neutrophil protein kinase C was activated by hemin in vitro, with a K(1/2) of 5 microM. Taken together, these results suggest a role for hemin as a proinflammatory agent able to induce polymorphonuclear neutrophil activation in situations of clinical relevance, such as hemolysis or hemoglobinemia.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12010821&dopt=Abstract hemorrhage
Neurology. 2002 May 14;58(9):1367-72.
Emergency craniotomy in patients worsening due to expanded cerebral hematoma: to what purpose?
Rabinstein AA, Atkinson JL, Wijdicks EF.
Department of Neurology, Neurological-Neurosurgical Intensive Care Unit, Saint Mary's Hospital, Mayo Clinic, Rochester, MN 55905, USA.
BACKGROUND: Supratentorial intracerebral hematomas often are evacuated in rapidly deteriorating patients. Surgery may prevent death but not necessarily disability. The authors studied the outcome of emergent clot evacuation in patients with worsening massive intracerebral hemorrhage. METHODS: The authors reviewed data on 26 consecutive, acutely worsening patients with nontraumatic intracerebral hemorrhage who had surgery for clot evacuation. All patients had clinical (stupor or coma, loss of pontomesencephalic brainstem reflexes, extensor posturing) or radiologic (midline shift of septum pellucidum > or =1 cm downward or obliteration of the ambient and suprasellar cisterns caused by displacement of the temporal uncus) signs of herniation. Outcome was defined using the Glasgow Outcome Scale (GOS). RESULTS: Fifty-six percent of patients died (GOS 1), 22% remained severely disabled (GOS 3), and 22% regained independence (GOS 4-5). Considering findings before surgery, upper brainstem reflexes were preserved more often in survivors (66% vs. 14%; p = 0.01). All patients who had a combination of absent pupillary, corneal, and oculocephalic reflexes and extensor posturing before craniotomy died. No patient lacking corneal or oculocephalic reflexes prior to surgery regained functional independence. CONCLUSIONS: Craniotomy for rapidly worsening patients with supratentorial intracerebral hemorrhage and radiologic signs of brain tissue shift may result in functional independence in approximately a quarter of patients. However, all comatose patients who lost upper brainstem reflexes and had extensor posturing died despite surgery.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12011282&dopt=Abstract hemorrhage
shed light on how hair loss might occur.
How long can hair grow before it stops growing eventually if it does?
Given that the hair growth rate is quite uniform and constant, somewhere between 0.3-0.5 millimeters per day, it's believed that the length of anagen, the growth phase, differs among individuals, and this is the major determinant to the maximum hair length. For some individuals, anagen may last ten years. Of course the length of the anagen is governed by genes, and the genetic background of the individuals. Non-genetic factors such as nutritional condition, weather, seasonal changes (hair may grow a bit faster during winter), taking medications, health condition may of course influence the rate of
hair loss.
The shape of the hair, straight or curly, is dependent on the shape of the follicle. A circular or round hair follicle would generate straight hair, while the follicle with oval or elliptical shapes (in its cross-section) would produce a curly hair.
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