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J Exp Med. 2002 Jun 3;195(11):1455-62.
The contribution of accessory toxins of Vibrio cholerae O1 El Tor to the proinflammatory response in a murine pulmonary cholera model.
Fullner KJ, Boucher JC, Hanes MA, Haines GK 3rd, Meehan BM, Walchle C, Sansonetti PJ, Mekalanos JJ.
Departments of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, 303 E. Chicago Ave., Morton 6-626, Chicago, IL 60611, USA. k-fullneorthwestern.edu
The contribution of accessory toxins to the acute inflammatory response to Vibrio cholerae was assessed in a murine pulmonary model. Intranasal administration of an El Tor O1 V. cholerae strain deleted of cholera toxin genes (ctxAB) caused diffuse pneumonia characterized by infiltration of PMNs, tissue damage, and hemorrhage. By contrast, the ctxAB mutant with an additional deletion in the actin-cross-linking repeats-in-toxin (RTX) toxin gene (rtxA) caused a less severe pathology and decreased serum levels of proinflammatory molecules interleukin (IL)-6 and murine macrophage inflammatory protein (MIP)-2. These data suggest that the RTX toxin contributes to the severity of acute inflammatory responses. Deletions within the genes for either hemagglutinin/protease (hapA) or hemolysin (hlyA) did not significantly affect virulence in this model. Compound deletion of ctxAB, hlyA, hapA, and rtxA created strain KFV101, which colonized the lung but induced pulmonary disease with limited inflammation and significantly reduced serum titers of IL-6 and MIP-2. 100% of mice inoculated with KFV101 survive, compared with 20% of mice inoculated with the ctxAB mutant. Thus, the reduced virulence of KFV101 makes it a prototype for multi-toxin deleted vaccine strains that could be used for protection against V. cholerae without the adverse effects of the accessory cholera toxins.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12045243&dopt=Abstract hemorrhage
Spine. 2002 Jun 1;27(11):E281-3.
Rapid, symptomatic enlargement of a lumbar juxtafacet cyst: case report.
Paolini S, Ciappetta P, Santoro A, Ramieri A.
Department of Neurological Sciences, Neurosurgery, Az. Osp. S. Maria, Terni, Italy.
STUDY DESIGN: A case is reported in which a 45-year-old man developed cauda equina syndrome caused by enlargement of an L4-L5 juxtafacet cyst diagnosed 4 months earlier. OBJECTIVES: To highlight the short interval that can elapse between the discovery of a juxtafacet cyst and its remarkable progression. SUMMARY OF BACKGROUND DATA: Although juxtafacet cysts are acquired lesions, how long they take to develop remains unclear. Hemorrhage is a well-known cause of rapid or even dramatic cyst enlargement. This is the first report providing magnetic resonance imaging evidence of rapid, remarkable enlargement of a nonhemorrhagic juxtafacet cyst. METHODS: The patient underwent conservative treatment for an L4-L5 right juxtafacet cyst diagnosed by magnetic resonance imaging during evaluation of posttraumatic lower back pain. Four months later, the patient presented with severe pain radiating down the right lateral leg, urinary retention, and impaired dorsal flexion of the right foot. Repeat magnetic resonance imaging showed the cyst now markedly enlarged and occupying almost the entire width of the canal. RESULTS: The cyst was removed, and the patient's symptoms abated. At 15 months after surgery, he is symptom-free. CONCLUSIONS: Juxtafacet cyst may occasionally enlarge and cause severe symptoms within months.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12045530&dopt=Abstract hemorrhage
J Trauma. 2002 Jun;52(6):1056-61; discussion 1061.
Rapid body cooling by cold fluid infusion prolongs survival time during uncontrolled hemorrhagic shock in pigs.
Norio H, Takasu A, Kawakami M, Saitoh D, Sakamoto T, Okada Y.
Department of Traumatology and Critical Care Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan.
OBJECTIVE: The purpose of this study was to examine whether cold fluid infusion could rapidly decrease the core temperature and prolong survival during uncontrolled hemorrhagic shock in pigs. METHODS: Fourteen pigs under light halothane anesthesia and spontaneous breathing underwent initial blood withdrawal of 25 mL/kg over 15 minutes, followed by uncontrolled hemorrhage (5-mm aortotomy). Immediately after the aortotomy, the pigs were randomized to receive 500 mL lactated Ringer's solution at either 4 degrees C (group 1, n = 7) or 37 degrees C (group 2, n = 7) over 20 minutes through the internal jugular vein and observed until their death or for a maximum of 240 minutes. RESULTS: The pulmonary artery temperature of group 1 decreased to 35.5 degrees +/- 0.3 degrees C after the infusion, then remained at 35.5 degrees C during the observation period. Pulmonary artery temperature values of group 2 remained at around 37.5 degrees C throughout the experiment. The mean survival time was 220 +/- 45 minutes in group 1 versus 136 +/- 64 minutes in group 2 (p < 0.05, life table analysis). The additional intraperitoneal blood loss of group 1 was similar to that of group 2 (9 +/- 4 g/kg vs. 10 +/- 5 g/kg). CONCLUSION: In lightly anesthetized pigs during uncontrolled hemorrhagic shock, infusion with 4 degrees C lactated Ringer's solution (which seems to be feasible in the clinical setting) decreases the core temperature rapidly and prolongs survival.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12045630&dopt=Abstract hemorrhage
J Trauma. 2002 Jun;52(6):1062-9; discussion 1070.
Dalteparin sodium treatment during resuscitation inhibits hemorrhagic shock-induced leukocyte rolling and adhesion in the mesenteric microcirculation.
Balogh Z, Wolfard A, Szalay L, Orosz E, Simonka JA, Boros M.
Department of Traumatology, Albert Szent-Gyorgyi Medical and Pharmaceutical Center, University of Szeged, Szeged, Hungary.
BACKGROUND: Ischemia/reperfusion-induced polymorphonuclear neutrophil leukocyte (PMN) adhesion and extravasation are pivotal for the development of postinjury multiple organ failure. We hypothesized that the deleterious microcirculatory consequences of hemorrhagic shock (HS) could be altered by low-molecular-weight heparin (LMWH) therapy. Our aim was to investigate the effects of dalteparin sodium on leukocyte-endothelial cell interactions when LMWH treatment was initiated before HS or during resuscitation. METHODS: Anesthetized dogs underwent HS (40 mm Hg mean arterial pressure for 60 minutes) and resuscitation either with shed blood or with lactated Ringer's (LR) solution. LMWH or conventional heparin sodium pretreatment was administered subcutaneously before hemorrhage; or LMWH was given intravenously during resuscitation. Mesenteric postcapillary venules were observed by intravital video microscopy before and after HS, and 60 minutes, 120 minutes, and 180 minutes after resuscitation, and leukocyte rolling and firm adherence were determined. RESULTS: HS significantly increased PMN rolling and adhesion in the mesenteric microcirculation. LMWH, but not heparin sodium pretreatment, significantly inhibited both primary and secondary interactions. LMWH treatment was also effective when initiated during resuscitation. LMWH exerted the same inhibitory effect regardless of the type of resuscitation. CONCLUSION: LMWH treatment during resuscitation effectively inhibits PMN rolling and adhesion.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12045631&dopt=Abstract hemorrhage
J Trauma. 2002 Jun;52(6):1091-6.
The efficacy and limitations of transarterial embolization for severe hepatic injury.
Hagiwara A, Murata A, Matsuda T, Matsuda H, Shimazaki S.
Department of Traumatology and Critical Care Medicine, Kyorin University, School of Medicine, Tokyo, Japan.
BACKGROUND: The efficacy of transarterial embolization (TAE) for severe blunt hepatic injury has been reported. We performed a prospective study evaluating the efficacy and the limitation of TAE from January 1996 to December 2000. METHODS: All patients with blunt abdominal injury who could be stabilized by fluid resuscitation underwent computed tomographic (CT) scan examinations. Patients with CT scan evidence of hepatic injury were classified into five grades according to CT scan findings on the basis of the injury scale of the American Association for the Surgery of Trauma (Mirvis classification). All patients with CT scan grade 3 to 5 injury underwent angiography. When angiography showed extravasation of contrast medium extending from hepatic arterial branches, TAE was performed. RESULTS: Of 612 patients with blunt abdominal trauma, 51 had CT scan grade 3 to 5 injury. Thirty-seven of these patients had a CT scan grade 3 injury and 18 underwent TAE. One of 19 patients who did not undergo TAE developed a delayed hemorrhage on day 6 and required a laparotomy. All 13 patients with a CT scan grade 4 injury had angiographic findings of the extravasation. TAE was successful in 11 patients and unsuccessful in 2. Five patients with a CT scan grade 4 injury required laparotomy. One developed a delayed hemorrhage on day 4. The remaining four patients had a major venous injury (a right lobectomy was performed in two with inferior vena cava injury, and a gauze packing in two with hepatic venous injury). One patient with a CT scan grade 5 injury underwent immediate laparotomy after TAE. Laparotomy revealed inferior vena cava injury and a right lobectomy was performed. Only two patients who underwent a lobectomy died of an uncontrollable hemorrhage. All CT scans of patients with hepatic venous or inferior vena cava injury showed a large low-density area (> or = 10 cm) with involvement of these vessels. The volumes of fluid resuscitation needed from admission until TAE ranged from 2,109 to 2,638 mL/h. CONCLUSION: It was considered that the combination of the presence of a CT scan grade 4 or 5 lesion and the fluid requirements of more than 2,000 mL/h to maintain normotension indicated the absolute necessity of surgery. We felt that these patients were not candidates for TAE, and should undergo immediate laparotomy.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12045635&dopt=Abstract hemorrhage
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