Acute Research Articles

Systemic inflammatory mediators in post-traumatic Complex Regional Pain Syndrome (CRPS I) - longitudinal investigations and differences to control groups

ObjectivesThe Complex Regional Pain Syndrome I (CRPS I) is a disease that might affect an extremity after trauma or operation. The pathogenesis remains yet unclear. It has clinical signs of severe local inflammation as a result of an exaggerated inflammatory response but neurogenic dysregulation also contributes to it. Some studies investigated the role inflammatory mediators and cytokines; however, few longitudinal studies exist and control groups except healthy controls were not investigated yet.MethodsTo get further insights into the role of systemic inflammatory mediators in CRPS I, we investigated a variety of pro-, anti-, or neuro-inflammatory mediators such as C-Reactive Protein (CRP), White Blood Cell Count (WBC), Interleukins 4, 6, 8, 10, 11, 12 (p70), Interferon gamma, Tumor-Necrosis-Factor alpha (TNF-α) and its soluble Receptors I/II, soluble Selectins (E, L, P), Substance-P (SP), and Calcitonin Gene-Related Peptide (CGRP) at different time points in venous blood from patients with acute (AC) and chronic (CC) CRPS I, patients with forearm fractures (FR), with neuralgia (NE), and from healthy volunteers (C).ResultsNo significant changes for serum parameters investigated in CRPS compared to control groups were found except for CC/C (CGRP p = 0.007), FR/C (CGRP p = 0.048) and AC/CC (IL-12 p = 0.02; TNFRI/II p = 0.01; SP p = 0.049). High interindividual variations were observed. No intra-or interindividual correlation of parameters with clinical course (e.g. chronification) or outcome was detectable.ConclusionAlthough clinically appearing as inflammation in acute stages, local rather than systemic inflammatory responses seem to be relevant in CRPS. Variable results from different studies might be explained by unpredictable intermittent release of mediators from local inflammatory processes into the blood combined with high interindividual variabilities. A clinically relevant difference to various control groups was not notable in this pilot study. Determination of systemic inflammatory parameters is not yet helpful in diagnostic and follow-up of CRPS I

Three-port versus four-port laparoscopic cholecystectomy in acute and chronic cholecystitis

BackgroundSeveral modifications have been introduced to laparoscopic cholecystectomy (LC). The three-port technique has been practiced on a limited scale. Our aim was to compare the three-port and four-port LC in acute (AC) and chronic cholecystitis (CC).MethodsThe medical records of 495 patients who underwent LC between September 1999 and September 2003 were reviewed. Variables such as complications, operating time, conversion to open procedure, hospital stay, and analgesia requirements were compared.ResultsTwo hundred and eighty-three patients underwent three-port LC and 212 patients underwent four-port LC. In total, 163 (32.9%) patients were diagnosed with AC and 332 (67.1%) with CC by histology. There was no statistical difference between the three and four-port groups in terms of complications, conversion to open procedure (p = 0.6), and operating time (p = 0.4). Patients who underwent three-port LC required less opiate analgesia (pethidine) than those who underwent four-port LC (p = 0.0001). The hospital stay was found to be related to the amount of opiates consumed (p = 0.0001) and was significantly shorter in the three-port LC group (p = 0.005).ConclusionThree-port LC is a safe procedure for AC and CC in expert hands. The procedure offers considerable advantages over the traditional four-port technique in the reduction of analgesia requirements and length of hospital stay.

Adrenomedullin mRNA is Highly Expressed in PBMC of Acute Kawasaki Syndrome

Introduction; Dilation of coronary arteries is a common finding in acute phase Kawasaki Syndrome (KS). The cause of this phenomenon remains unknown. Macrophages and lymphocytes are known to infiltrate into the arterial wall of KS patients. These cells are producers of vasodilatory agents such as nitric oxide synthetase (NOS), calcitonin-related gene protein and adrenomedullin (ADM). The purpose of the current study was to examine the expression of three vasodi lators in acute and convalescent KS. Patients and Methods; Twenty-two KS patients were enrolled in this study. Blood drawing was performed on around 4th disease day for acute KS and around 20th disease day for convalescent KS patients. Five microgram of RNA from PBMC of each sample was processed to make cRNA and Genechip cDNA microarray (Affymetrix) was performed in four patients. Semi-quantitative RT-PCR was also done with another six KS patients also in acu te and convalescent phase. Plasma levels of ADM were assayed in twelve KS patients with RIA kit (Peninsula Labs.). All statistics were performed using Students' paired-t test. Results; No differences were observed in mRNA expression by microarray analysis of the vasodilatory agents, NOS and calcitonin-like gene protein between acute vs convalescent phases of 4 patients with KS initially studied. In contrast, ADM showed high-level mRNA expression in acute KS which w as 7 fold-higher and showed statistically significant difference (p<0.05) from mRNA expression in convalescent KS. In RT-PCR of 6 additional patients, the same results were obtained. All six patients had high expression of ADM mRNA in acute p hase a nd showed statistically significant difference from convalescent phase (p<0.05). Plasma levels of ADM protein were also high in acute phase and normalized in convalescent phase. Conclusion; ADM may contribute to the coronary artery dilation found in acute Kawasaki Syndrome.

Effect of cisplatin and paclitaxel on plasma free tryptophan levels. An in vitro study.

Emesis is a common side effect of some antineoplastic drugs. Cisplatin (CP) induces a biphasic pattern of emesis referred to as acute (AE) and delayed (DE) emesis. The serotonergic system plays a major role in the pathogenesis of CP-induced AE, as suggested by the therapeutic efficacy of 5HT3 receptor antagonists. The pathogenesis of CP-induced DE are not clear. To date, there are no pharmacological agents which satisfactorily control DE. We hypothesize that increased availability of tryptophan (TRP) for the synthesis of brain serotonin (5-HT) could, at least in part, contribute to CP-induced DE. In fact, within 2-4 hrs of administration, CP is largely bound to albumin (ALB) with consequent possible displacement of TRP which circulates in plasma mostly (90% of total plasma TRP) bound to its natural carrier, ALB. To test this hypothesis, we studied in vitro the effect of increasing doses of cisplatin on F-TRP in plasma obtained from healthy volunteers. We also tested the effects of therapeutic amounts of paclitaxel, an antineoplastc agent which does not cause emesis. F-TRP concentrations increased in a dose-dependent manner following incubation with cisplatin, in contrast to paclitaxel (PTX). The preliminary data obtained suggest that CP, but not PTX, at therapeutic doses, increases plasma F-TRP concentrations. This increase has likely negligible relevance in CP-induced AE, which is induced by the 5-HT released by the enterochromaffin cell system, while it might play a role in the pathogenesis of CP-induced DE. In fact, CP binding to ALB is stable for 4-5 days following administration, thus suggesting long-term TRP displacement from ALB and enhanced brain 5-HT synthesis and release. Whether increased TRP availability for 5-HT synthesis might be the pathogenic mechanism for CP-induced DE in vivo, is currently being tested.

Role of immune complexes from patients with different clinical forms of schistosomiasis in the modulation of in vitro granuloma research.

Schistosomiasis is a disease whose pathology is strongly related to the granulomatous reaction formed around parasite eggs trapped in host tissues. Studies have shown that the chronic intestinal form (INT) of this infection is associated with a variety of immunoregulatory mechanisms which lead to a diminished granulomatous reaction. Using an in vitro model of granuloma reaction, we show that immune complexes (IC) isolated from sera of INT patients are able to reduce granulomatous reaction developed by peripheral blood mononuclear cells (PBMC) from acute (AC), INT and hepatosplenic (HE) patients to soluble egg antigen (SEA)-conjugated polyacrylamide beads (PB-SEA). This inhibitory activity is also observed in cell proliferation assay of PBMC from INT and HE patients stimulated with SEA and adult worm antigen (SWAP). Furthermore, IC isolated from sera of patients with different clinical forms of the disease are also able to suppress INT patients PBMC reactivity. Therefore, our results show that circulating IC present in sera of patients with different clinical forms of schistosomiasis may downregulate PBMC reactivity to parasite antigens resulting in a diminished granuloma reaction to parasite eggs.

Effects of acute and chronic cocaine on breathing and chemosensitivity in awake rats.

The barometric method was used to study effects of acute (AC) and chronic cocaine (CC) on breathing and chemosensitivity in awake rats. Effects of AC were evaluated 15 min after daily intraperitoneal injections, and effects of CC were measured at each week of the 4-wk treatment. Sham rats (group 1, n = 10) were injected with NaCl (0.2 ml). Cocaine HCl was given daily in groups 2 (20 mg/kg, n = 5) and 3 (40 mg/kg, n = 10). Effects of AC on the respiratory responses to 10% O2 in N2 and 5% CO2 in 21% O2 were studied 15 min after the first injection of cocaine. Effects of CC on chemosensitivity were studied at weekly intervals. NaCl had no effects on the breathing pattern or chemosensitivity. During normoxia, AC caused an increase in respiratory rate in group 2 and rapid and shallow respiration in group 3. The effects were similar from the first to the last injection at week 4. Haloperidol, a dopamine (DA) receptor blocker, abolished (group 4, n = 8) or prevented (group 5, n = 9) effects of AC. CC had no effects in all normoxic rats. During exposure to either low O2 or high CO2 the AC-induced polypnea was replaced by deep and slow respiration. CC had no effects on CO2 response in all rats. In contrast, 10% O2 response of tidal volume in group 2 and minute ventilation in group 3 were attenuated at weeks 3 and 4 compared with control.(ABSTRACT TRUNCATED AT 250 WORDS)

Beta-adrenergic blockade does not prevent the lactate response to exercise after acclimatization to high altitude

We examined the extent to which epinephrine influences blood lactate adjustments to exercise during both acute (AC) and chronic (CH) high-altitude exposure. Eleven male sea level residents were divided into a control group (n = 5) receiving a placebo or a drug group (n = 6) receiving 240 mg/day of propranolol. All subjects were studied at rest and during 45 min of submaximal exercise (approximately 50% of sea level maximal O2 uptake) at sea level (SL) and within 4 h of exposure to and after 3 wk residence at 4,300 m (summit of Pikes Peak). Blood samples were collected from the femoral artery for epinephrine and lactate concentration. Exercising blood lactate concentration was significantly different across all altitude conditions such that AC > CH > SL (P < 0.05). For a given arterial O2 saturation, mean exercising blood lactates were lower for the beta-blocked group compared with controls; however, both groups demonstrated similar patterns across all conditions. Epinephrine levels during exercise followed a similar pattern to that of lactate, averaging 0.67, 0.43, and 0.29 ng/ml for AC, CH, and SL, respectively. The correlation between lactate and epinephrine was 0.93 and 0.84 for control and beta-blocked subjects, respectively. Whereas during exercise epinephrine was consistently higher for the beta-blocked group than controls, this difference was only significant during CH exposure. The epinephrine response was related to the extent of hypoxia in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Aldosterone regulation of active sodium chloride transport in the lizard colon (Gallotia galloti)

Bioelectrical parameters and unidirectional sodium and chloride fluxes were measured under voltageclamp conditions in groups of lizards submitted to single or chronic aldosterone treatment. Both acute (AT) and chronic (CT) treatment induced significant increases in the short-circuit current (Isc), as well as in the mucosa-to-serosa (Jm-sNa) and net sodium flux (JnetNa). In AT tissues, aldosterone did not change net chloride flux (JnetCl) but did so in CT tissues. Amiloride reduced the aldosterone-increased Isc in AT and CT tissues, inhibited JnetNain AT tissues and abolished it in CT colons. JnetClwas also reduced by the diuretic in the group of AT colons, whereas no changes were observed in the CT tissues. Addition of luminal DIDS reduced Na+ absorption and totally inhibited Cl- absorption in the AT tissues, but did not change Isc. However, in CT tissues neither Na+ nor Cl- transport were affected by DIDS. A good relationship between Isc and Jm-sNawas apparent after DIDS treatment in AT tissues. In this group, simultaneous addition of DIDS and amiloride totally abolished JnetNaand reduced Isc to untreated control values. Addition of serosal ouabain abolished Isc and Na+ absorption in AT and CT colons, but Cl- absorption was only altered in AT tissues. These results support the hypothesis that aldosterone induces an electrogenic, amiloride-sensitive sodium absorption, and in a dose-dependent fashion suppresses electroneutral NaCl absorption in the lizard colon.

Regulation of amiloride-sensitive Na + absorption in the lizard ( gallotia galloti) colon by aldosterone

1. 1. Acute (AT) or chronic (CT) administration of exogenous aldosterone brought about a considerable increase in transmural potential difference (PD), short-circuit current (Isc) and net sodium flux ( J net Na ). 2. 2. A good relationship between Isc and J m- s Na was observed in CT but not in AT or UC (untreated controls). 3. 3. Addition of mucosal amiloride reduced Isc in AT and CT colons, but did not cause any change in UC colons. The relationship between Isc and J m- s Na , observed in CT was totally suppressed by the diuretic. 4. 4. J net Na was reduced in AT tissues and abolished in CT colons by amiloride. 5. 5. The present results strongly suggest that aldosterone levels quantitatively and qualitatively modify sodium absorption across colonie mucosa in a dose-dependent fashion and that lower levels of the hormone are required to induce the electrogenic Na absorption than to suppress the electroneutral transport.

Restriction of measles virus gene expression in acute and subacute encephalitis of Lewis rats

Measles virus (MV) replication in brain tissue of Lewis rats with acute (AE) and subacute (SAME) encephalitis was characterized by biochemical techniques. Messenger RNAs specific for measles virus nucleocapsid (N), phospho (P)-, matrix (M), fusion (F), and haemagglutinin (H) protein were detected in all brain extracts examined. The quantity of the individual MV mRNA species was quite different in comparison to lytically infected Vero cells. A steep gradient of MV transcripts was found in brain tissue which is most likely due to strongly attenuated transcription of mRNAs along the viral genome, representing particularly low transcription of the glycoprotein genes. In addition, in vitro translation assays only revealed synthesis of N and P protein in consistent fashion. The mRNAs for the glycoproteins did not direct the synthesis of detectable viral proteins whereas the M mRNA revealed some activity in animals with AE. The data indicate a strong restriction of the MV envelope gene expression in infected brain tissue, which is independent of the incubation time and type of the central nervous system (CNS) disease. This phenomenon which is similar to the findings observed in measles inclusion body encephalitis and subacute sclerosing panencephalitis suggest that host factors may initially be responsible for the initiation of transcriptional and translational alterations.

Editorial: ESC and its Ways

E D IT O R IA L E S C A N D IT S W AYS E v e r y three years, English Studies in Canada applies to the Social Sciences and Humanities Research Council of Canada for a grant in aid of publication. Last year the application, in addition to the usual statistics, required many pages describing the journal’s objectives, history, authorship, service to Cana­ dian scholarship, editorial practices, and reach. It occurred to us thrifty edi­ tors that such information might serve a double purpose: that in addition to swelling the archives of a granting agency, it might be even more useful in acquainting the membership of ACU TE more fully with the nature of their own journal, what it does, and why it does it. With the Executive’s approval, I have therefore rewritten the material of our SSHRCC submission, cutting redundancies and amplifying where I thought our members would like fuller information. Our object in the account that follows is not to rigidify present practice or suggest that it is the only way of doing things properly, but merely to make people aware of what their journal does so that, if change be con­ templated, it may be carried out knowledgeably. English Studies in Canada is the journal of the Association of Canadian University Teachers of English. The objective of the journal is to provide a Canadian vehicle for learned critical, theoretical, and scholarly discussion of literature in English from its beginnings to the present. It therefore pub­ lishes articles on and reviews of books about everything from Old English to Canadian and Commonwealth literature. In this focus and spread, it reflects the interests of the association that sponsors it and which includes professionals working in all the periods and divisions of English. We try to represent this range of interests comprehensively and fairly. The average issue starts with an article on some author or aspect of early English and proceeds period by period from the Renaissance to the eighteenth, nineteenth, and twentieth centuries. The approaches taken are similarly comprehensive, including tra­ ditional scholarly studies — philological, historical, contextual — as well as innovative and theoretical studies in the various compartments of modem criticism. The journal, then, is interested in the scholarly exploration of Eng­ lish literature in its widest sense, and also in the critical and scholarly instruE n g l i s h S t u d i e s in C a n a d a , x v , i , March 1989 ments and techniques by means of which such exploration may be conducted. The scope of the journal allows for study of large-scale literary phenomena in a significant body of material, study of individual authors and works, and examination of the principles and theory of literary study itself. In short, it is open to the whole professional and scholarly field of English studies, compre­ hending both the variety and the coherence of the major discipline it reflects. In its range and focus, English Studies in Canada is, I believe, unique, sub­ stantial, and of the first importance in the humanities in Canada. Given its range of material and readers, from medievalists to Lacanian postmodern feminists, I occasionally sense some uncertainty among assessors as to the degree of specialization that we should allow in any particular area. On the whole, and with some reservations, I take the view that any reasonably educated scholar of English literature should be able to follow the interests and intricacies of any part of the study, though he or she may not be avidly interested in all of them. I recall here, attending an Oxford sherry party where, with my usual social desperation, I tried to make myself agreeable by asking an Oxford English don what his special field of interest was. Fixing me with a smirk as of one about to apply the squelch definitive to a narrow, compartmentalized, and ill-educated colonial, American, or whatever, he smugly replied, “English literature.” How pleasant, as Twain reportedly observed, to have all the confidence of a Christian with four aces. Never­ theless, he was asserting, in however offensive a way, a soundly valuable point of view, that our...

Complaint patterns of patients with irritable bowel syndrome, crohn's disease and acute gastroenterological illness

Chronic gastroenterology patients with noncritical [irritable bowel syndrome (IBS)] and grave illness [Crohn's disease (CR)] were compared with mixed acute (AC) cases, e.g. GI virus, on the Cornell Medical Index Health Questionnaire (CMI). The total N = 280 comprised 66 IBSs, 34 CRs and 40 ACs per sex. Reliability of coding ‘yes’, i.e. complaint, responses for all rs and ϱ s was above 0.96 per Dx group. For the 18 separate CMI categories, and also with the 12 ‘somatic’ classes plus the sum of ‘emotional’ items, MANOVAs on both raw scores and ranks showed strong between-Dx-groups effects, all Ps < 0.005, and even stronger sex differences, since women far outcomplained men, all Ps < 0.002. Univariate ANOVAs gave significant outcomes by sex on 2 3 and by Dx on 1 3 of the CMI categories, but not on number of digestive tract complaints nor any discrete ‘emotional’ category. The usual data pattern was IBS > AC > CR, as were significant χ 2 and discriminant function analyses on single items per sex. IBS women made many vague complaints vs few, but disease-congruent, by CRs; ACs were intermediate. Complaints by IBS men were also nonspecific but mainly on different items, and CRs gave relatively more disease-congruent complaints. Discriminant functions correctly allotted 67.2% of women—via 10 items— and 70.9% of men—via 11 items—to Dx groups. The results depart from some common IBS stereotypes and we propose a technical distinction between ‘crocks’ vs ‘kvetches’.

Alcohol-induced testicular atrophy in the adult male rat.

The effect of ethanol feeding on testicular function and structure in adult male rats was studied in alcohol-fed animals, isocalorically fed controls, and weight-starved controls. Testicular weight was reduced by more than 50% in alcohol-fed animals compared to the control groups. Marked disruption of the histological appearance of the testes was observed in the alcohol-fed animals when compared to the controls. Specifically, there was prominent reduction in the mean seminiferous tubule diameter (P < 0.01) and number of contained germ cells (P < 0.01). Plasma levels of testosterone (P < 0.01) were reduced in the alcohol-fed animals when compared to either of the two control groups. In contrast, plasma estradiol levels were reduced in the alcohol-fed and weight-starved animals when compared to those of the isocaloric controls {P < 0.05). Plasma FSH levels in the alcohol-fed animals were twice those of the controls (P < 0.01), while no difference in plasma LH levels was observed among the various groups. Acu te alcohol infusion in castrate rats produced a significant reduction (P < 0.05) in plasma LH and reduced the responses of both FSH and LH to LRF stimulation (P < 0.05). LRF stimulation of castrate alcohol-fed rats was followed by an even greater reduction in the LH response (P < 0.01). These results establish that: 1) ingestion of a diet containing 5% ethanol can produce gonadal atrophy and reduce plasma testosterone and estradiol levels in adult male rats; 2) such gonadal injury occurs despite the absence of important biochemical or structural liver disease and can not be ascribed to caloric deprivation associated with chronic ethanol ingestion; 3) ethanol infusion of castrate rats acutely reduces basal LH secretion and blunts the response of such rats to LRF; and 4) LRF responses of castrate rats chronically fed alcohol are markedly reduced when compared to those of either castrate isocaloric or weightstarved controls

An Interview with Clarence Tracy

A N I N T E R V I E W W I T H C L A R E N C E T R A C Y G.D. KILLAM University of Guelph (Clarence Tracy and I talked about his long career in university teaching in his home at Port Maitland in Nova Scotia. All of the friends and former colleagues whose words appear in this profile mention the comfortable, relaxed, easy hospitality of the Tracy home whether in Fredericton, Saskatoon, Vancouver, Wolfville, or Port Maitland. Such it was on the day we had together (one of many). This year marks the twenty-first anniversary of the founding of acute, with which Clarence Tracy was involved. The advantages to our profession of the creation of the Association are plain enough. What was it like before acute came into being? I asked Clarence: killam "Could you comment on the state of affairs in our profession before the founding of acu te, and on the aims, objectives, and achievements of acute since its founding twenty-one years ago?" tracy "I'm in a good position because I'm old enough to remember vividly what that state was, having taught for twenty years before acute was founded, and also because I spent most of that twenty years in the West in a state of isolation from colleagues who were interested in the same things I was. I was about the only person between Toronto and Vancouver who was interested in the eighteenth century and with salaries what they were in those days, travel was difficult; I never saw anybody who was interested in the eighteenth century, except on rare accidental occasions. There was little or no money for subsidizing travel or research. In that twenty years I probably got $500.00 altogether for secretarial help in scholarly work and for buying a few films and that kind of thing. So the foundation of acute for me, at any rate, primarily marked the establishment of a scholarly community to which one could belong, and the annual meetings not only provided interesting papers but even more than that an opportunity to meet and talk with one's colleagues and to turn over ideas." killam " I take it that your colleagues in the profession shared your feelings about this lack of com m unity?" tracy "Oh, I think so. Of course, people in the bigger centres like Toronto were closer to their American colleagues and were rather better paid and so got around a little better than I was able to do. I remember Mr Woodhouse En g lish Studies in Ca n ad a, iv , 2, Summer 1978 1 3 0 expressing the view on more than one occasion that the Canadian scholarly community simply had no way of getting together." killam "So you think that the project has been a continuing fruitful thing?" tracy "I think that it's been a very good thing. I sometimes feel that we now have too many learned societies and too many meetings. Many a good thing is apt to go a little too far; but on the whole if it is a fault, it is very much on virtue's side." killam "Do the same sorts of comments apply then to the Humanities Associa­ tion? Or is it different there?" tracy "The Humanities Association is earlier than acu te. But I don't think it has succeeded quite so well, primarily because its objectives were more vast and somewhat nebulous. Its aim was to bring together all academic disciplines and, in metaphorical terms, the clergy and the laity, ie, the professionals and the non-professionals. To some extent it has succeeded but only to a limited one, because it's been very difficult to get the professional scholars in some centres to interest the laity, the general public. They tend to treat the branch as a kind of professional commonroom where they can get together to discuss their own problems away from the non-academics. The non-academics, on the other hand, have been reluctant to join because they felt inferior. When I was in the Saskatoon branch we made great efforts to bring in high...

Colonic fistulization due to pancreatitis

S PONTANEOUS COLONIC FISTULIZATION due to p a n c r e a t i t i s is u n c o m m o n ; on ly four teen recorded cases were found in a rev iew of the l i t e ra ture . T h e purpose of th is r e p o r t is to record the c l in ical and pa tho log ic fea tu res of four a d d i t i o n a l cases encoun te red a t the Los Angeles C o u n t y H o s p i t a l dur ing the l as t t w e n t y years . Two s ignif icant f ea tu res were demons t r a t e d b y these cases. F i s t u l i z a t i on never occur red dur ing the in i t ia l acu te phase of pancrea t i t i s , r a t h e r i t t ook p lace l a t e r dur ing the evo lu t ion of pe r ipanc rea t i c s u p p u r a t i o n or pseudocys t . Also, f i s tu l iza t ion fai led to influence f a v o r a b l y the course of t he p r i m a r y disease. I t n o t on ly fai led to decompress the pe r ipanc rea t i c col lect ion successful ly as m i g h t be expec ted b u t also a p p e a r e d to induce m a j o r hemor rhage and dea th .

AN EXPERIMENTAL EVALUATION OF THE EFFECT OF A PLASTIC ADHESIVE, METHYL 2-CYANOACRYLATE, ON NEURAL TISSUE.

D URING the las t several years , surgeons have d e m o n s t r a t e d a good dea l of in te res t in a new adhes ive , m e t h y l ~ -cyanoac ry la t e ( E a s t m a n 910 adhes ive) . This p las t ic adhes ive is a m e m b e r of the a lky l ~ -cyanoac ry l a t e fanii ly. I t sets r ap id ly , be ing po lymer i zed b y t races of water , and affords an excep t iona l ly s t rong bond. 5 F u r t h e r m o r e , t he adhes ive appears to be self-s ter i l iz ing ~ and, to da te , the re have been no r epor t ed infections s econda ry to i ts use. a,s,9 As a resul t , m a n y inves t iga tors have used m e t h y l ~-cya n o a c r y l a t e as a biological adhes ive bo th expe r imen ta l ly and cl inical ly, no t on ly to repa i r a r te r ia l wounds 3,7 b u t to close skin incisions and anas tomose boweP as well. These repor t s have s t i m u l a t e d neurosurgeons to use the 910 adhes ive . Arak i et al. 2 coa ted in t r ac ran ia l aneu rysms wi th the adhes ive in an imals and in humans . Albin et al. 1 have also ut i l ized the adhes ive to graf t pa tches of Teflon to dura l defects in (togs wi th good results. Ca r ton and his associa tes 4 r ecen t ly r epo r t ed the repa i r of a t ea r a t the base of an in te rna l ca ro t id aneurysm. T h e 910 adhes ive was used to p a t c h du ra m a t e r over the defect ; pos tope ra t i ve ang iograms d e m o n s t r a t e d t h a t the in te rna l ca ro t id a r t e r y r ema ined pa ten t . Severa l inves t iga tors 4,s,~~ have cal led a t t e n t i on to an acu te i n f l a m m a t o r y reac t ion a r o u n d a r t e r io tomies closed wi th 910 adhesive and to th rombos i s of vessels whose i n t ima has come in con tac t wi th the adhesive. However , in spi te of the widespread use of m e t h y l ~ -cyanoacry la te , careful a d e q u a t e l y