Degree Of Tissue Destruction Research Articles

Choroid plexus volume is enlarged in clinically isolated syndrome patients with optic neuritis

Objectives: We investigated choroid plexus (CP) volume in patients presenting with optic neuritis (ON) as a clinically isolated syndrome (CIS), compared to a cohort with established relapsing–remitting multiple sclerosis (RRMS) and healthy controls (HCs). Methods: Three-dimensional (3D) T1, T2-FLAIR and diffusion-weighted sequences were acquired from 44 ON CIS patients at baseline, 1, 3, 6 and 12 months after the onset of ON. Fifty RRMS patients and 50 HCs were also included for comparison. Results: CP volumes was larger in both ON CIS and RRMS groups compared to HCs, but not significantly different between ON CIS and RRMS patients (analysis of covariance (ANCOVA) adjusted for multiple comparisons). Twenty-three ON CIS patients who converted to clinically definite MS (MS) demonstrated CP volume similar to RRMS patients, but significantly larger compared to HCs. In this sub-group, CP volume was not associated with the severity of optic nerve inflammation or long-term axonal loss, not with brain lesion load. A transient increase of CP volume was observed following an occurrence of new MS lesions on brain magnetic resonance imaging (MRI). Interpretation: Enlarged CP can be observed very early in a disease. It transiently reacts to acute inflammation, but not associated with the degree of tissue destruction.

Management of esophageal perforations and postoperative leaks

: Esophageal perforations and postoperative leaks are challenging and life-threatening conditions, with a not well-defined management, yet. Perforation is defined as a full-thickness tear in the esophageal wall due to a trauma on the esophageal lumen or to a sudden increase of endoluminal pressure, like in spontaneous perforations. The most frequent causes are: iatrogenic injuries, spontaneous perforations, foreign body or caustic ingestion, trauma, tumors etc. The onset of symptoms varies depending on the location of perforation (cervical, intrathoracic or intraabdominal), the degree of tissue destruction and extension of contamination of surrounding organs, the cause, the timing of diagnosis and the presence of underlying esophageal disorders. Post-operative esophageal leaks have a different origin but a quite similar clinical presentation and treatment to esophageal perforations. The higher reported incidence is after cervical esophagogastric anastomosis, followed by intrathoracic anastomosis (above all after trans-hiatal one). It is already proven that short diagnostic timing and correct treatment can reduce mortality of 50%. Recent evidence also shows how better outcomes are achieved when the management is multidisciplinary, led by an expert team, and individualized treatments are adopted, involving all available modalities (medical, endoscopic and surgical). The purpose of this article is to review current standard practice, expert opinions and outcomes in the management of esophageal perforations and postoperative leaks.

Optimization of hyperthermia process applied to cancer treatment using multi-objective optimization differential evolution

Due to the number of cancer cases diagnosed each year and the fatality rate resulting from some more severe types, the improvement of less invasive and more efficient treatment techniques is of great importance. In this context, hyperthermia is a medical procedure in which the tumor region is heated by using an applicator for a certain period, aiming to destroy pathological cells. Computational models can be used to simulate the heating effect of tumors and adjacent cells. In general, the solution to an optimization problem considering factors such as heating temperature, applicator position, and the time in which the region will be subjected to heating can provide important information about the procedure. Traditionally, this type of problem has been addressed in a single objective context, focusing on minimizing the destruction of adjacent healthy tissue considering the area of the applicator constant. Our fundamental objective is to propose a multi-objective design problem considering the minimization of the area subject to the procedure and the time required for the process of hyperthermia in a breast cancer treatment. The problem is constrained by the degree of tissue destruction and by a partial differential equation that describes the phenomenon of heat transfer in both healthy and tumor tissues. The results obtained demonstrate that a point with a good compromise between the objectives can be chosen in such a way that a particular strategy can be defined for each patient.

Co-presentation of Acute Sheehan Syndrome with Raised Intracranial Pressure in a Post-partum Lady

Sheehan’s syndrome (SS) or necrosis of pituitary gland is a rare complication of severe postpartum hemorrhage. It may cause hypopituitarism immediately or several years later, depending on the degree of tissue destruction. Sheehan’s syndrome though rare is still one of the commonest causes of hypopituitarism in developing countries like ours. The presence of an intercurrent infection and administration of thyroxine exacerbated her corticosteroid insufficiency. Intracranial hypertension (IH) manifested as bilateral optic disc swelling with reduced visual acuity, bilateral sixth nerve palsies, and impaired consciousness. Intracranial hypertension (IH) has been associated with hypocortisolism caused by either primary adrenocortical insufficiency or corticosteroid withdrawal. The author describes a case of a young lady with IH with acute SS who presented on 3rd day postpartum after lower uterine cesarean section with acute severe symptomatic hyponatremia which was complicated by postpartum hemorrhage. The clinical manifestations of IH resolved with corticosteroid replacement

Anatomy of a steam pop – Acute histopathology in human myocardium after ventricular tachycardia ablation

Despite an improved understanding of the biophysics of radiofrequency (RF) energy delivery, steam pops remain a potentially serious complication of RF catheter ablation. Excessive heating and boiling resulting in intramural gas eruption from myocardial tissue can lead to cardiac perforation and may require emergent surgical repair.1,2 Visualization of the histopathologic changes, the degree of tissue destruction, and comparisons to non–steam pop RF ablation have not been reported in human myocardium in the acute phase.

97. The effect of physical therapy on time to discharge after lumbar interbody fusion

BACKGROUND CONTEXT With a lesser degree of tissue destruction and lower postoperative opiate burden, patients undergoing minimally-invasive spine surgery are primed to benefit from early mobilization, which can further enhance recovery and hasten rehabilitation after surgery. PURPOSE To determine the role of physical therapy on earlier postoperative discharge after minimally-invasive transforaminal lumbar interbody fusion (TLIF). STUDY DESIGN/SETTING Cohort study. PATIENT SAMPLE All patients undergoing one- and two-level minimally-invasive TLIF for degenerative lumbar diseases were operated on by the senior author from January 1, 2016 until August 31, 2018. Demographic data, comorbidities, preoperative patient-reported outcomes (PROs), intraoperative parameters, and postoperative measures were abstracted from a prospectively maintained database, ie, Michigan Spine Surgery Improvement Collaborative (MSSIC). Data on ambulation were collected from the physical therapy notes. OUTCOME MEASURES The primary outcome measure is postoperative length of acute care stay. Length of stay was divided into (1) discharge on postoperative day 1 (POD 1 cohort), (2) discharge on postoperative day 2 (POD 2 cohort), and (3) discharge on ≥3 postoperative days (POD ≥3 cohorts) to maintain three equal-time cohorts. METHODS An ordinal logistic regression model was fitted to the data to estimate the effect of discharge on postoperative day 1 vs postoperative day 2 vs postoperative ≥ day 3. Anesthesiology (ASA) classification was used as a surrogate marker of comorbidity burden. RESULTS Of the 90 patients, the day of first ambulation with physical therapy increased from a mean of 14.4 ± 9.6 hours after surgery in the POD 1 cohort, 19.2 ± 7.2 hours in the POD 2 cohort, to 24.0 ± 12.0 hours in the POD ≥3 cohort (p=0.009). Furthermore, mean distance ambulated upon first interaction with physical therapy decreased from 162.8 ± 127.5 feet in the POD 1 group, 111.2 ± 83.6 feet in the POD 2 group, to 58.7 ± 59.3 feet in the POD ≥3 group (p CONCLUSIONS Time to first ambulation with a therapist independently increases the odds of earlier discharge. Regardless of preoperative patient-reported outcomes, ambulation remains a stronger predictor of discharge. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

The Role of the Urokinase-Type Plasminogen Activator System In Tumor Progression

In the multistage process of carcinogenesis, invasion of malignant cells into normal tissue and their distribution as well as the degree of tissue destruction are the key links in tumor growth and progression. The urokinase-type plasminogen activator system (uPA system) plays the most important role in the development of these processes. The uPA system consists of several components: serine proteinase—uPA, its receptor— uPAR and its two endogenous inhibitors – PAI-1 and PAI-2. The role of uPA, a highly specific protease, consists in triggering the processes performed by the uPA system, which result in destruction of connective tissue matrix (CTM) and basal membranes as well as activation of numerous extracellular and intracellular signaling pathways. uPA converts plasminogen into plasmin and in addition to the regulation of fibrinolysis, it can hydrolyze a number of CTM components and activate zymogens of secreted matrix metalloproteinases (MMРs)—pro-MMРs. MMРs can hydrolyze all the main СTM components and thus play a key role in the development of invasive processes, as well as to perform regulatory functions by activating and releasing from CTM a number of biologically active molecules involved in the regulation of the main processes of carcinogenesis. uPA, PAI-1 and PAI-2 not only regulate uPA/uPAR activity; they are also involved in proliferation, apoptosis, chemotaxis, adhesion, migration, and activation of epithelial-mesenchymal transition pathways. All the above mentioned processes are aimed at regulating invasion, metastasis and angiogenesis. The components of the uPA system are used as prognostic and diagnostic markers of many cancers, as well as serve as targets for anticancer therapy. Selective uPA inhibitors, uPAR peptide antagonists, monoclonal antibodies that can prevent uPA binding to uPAR, as well as antisense oligonucleotides directed against uPA and uPAR are intensively studied in this context as putative and actual pharmacological agents.

Foot Reconstruction of Severe Bone and Soft Tissue Landmine Injury

Landmine Injury to the foot and ankle as high-force energy can be devastating to a different structure including bone, muscles, vessels, and nerves. The degree of tissue destruction and often other surgical evaluation most likely to affects the decision of whether to amputate or attempt a reconstruction. In Literature, previous studies show that immediate amputation in patients with high Mangled Extremity Severity Score (MESS) had a very good prognosis compared with reconstruction. In this paper, we report a case of a 28-male presented to the Emergency Department at ALJALA hospital after 30 minutes of crushing his right foot by direct contact with a landmine. Assessment of the patient revealed poor general state and the foot was severely mangled despite >7 on Mangled Extremity Severity Score (MESS). Limb salvage was used with Aggressive debridement, reduction with external fixation, skin graft with big toe amputation and later replace of skin graft with sural flap. After one year of treatment, all wounds healed completely with little pain, satisfactory motor and sensory functions were achieved and the patient returns to his previous job as vehicle driver. In conclusion, the treatment of mangled extremity should be based on clinical evaluation of every patient. Guidelines and scores are helpful, but should not be considered as fundamental criteria in clinical decisions.

Petrographic and mineralogical studies of fossil charcoal from Sierra de Bahoruco (Barahona Province, Dominican Republic)

The volcanic formations of the Sierra de Bahoruco mountain range (Barahona Province, Dominican Republic) contain charred fragments of plants, mainly tree trunks, which are composed of dense concentrations of hard mineralized fusain, with diverse microstructures. Petrographic examinations confirmed occurrence of two types of fusinite - structural fusinite with well-preserved tree tissue fragments, and detrital fusinite originating probably from softer tissues of tree phloem. In addition to the fusinite varieties developed from tree trunks and roots, charred tissues of dead external part of trunk epidermis affected by the microbiological process of rotting were identified. Poorly marked seasonal growth rings of trees, the shape and distribution of tree tissues, as well as the degrees of tissue destruction, indicated that the fragments originated from tropical trees growing in specifically marked rain and dry seasons, while wood tissues, charred by the fall of hot volcanic dust, suggested the existence of a monsoon tropical forest on the area. Fusinite was strongly impregnated with calcite and pectolite, sometimes zeolites (prehnite) and chlorite. It was accompanied by iron and copper sulphides, i.e. pyrite, chalcopyrite, and chalcocite. The latter minerals occurred in magma and pyroclastic formations, strongly associated with hydrothermal activities.

Diffusivity in multiple sclerosis lesions: At the cutting edge?

BackgroundRadial Diffusivity (RD) has been suggested as a promising biomarker associated with the level of myelination in MS lesions. However, the level of RD within the lesion is affected not only by loss of myelin sheaths, but also by the degree of tissue destruction. This may lead to exaggeration of diffusivity measures, potentially masking the effect of remyelination.ObjectiveTo test the hypothesis that the T2 hyperintense lesion edge that extends beyond the T1 hypointense lesion core is less affected by tissue loss, and therefore a more appropriate target for imaging biomarker development targeting de- and re-myelination.MethodPre- and post-gadolinium (Gd) enhanced T1, T2 and DTI images were acquired from 75 consecutive RRMS patients. The optic radiation (OR) was identified in individual patients using a template-based method. T2 lesions were segmented into T1-hypointense and T1-isointense areas and lesion masks intersected with the OR. Average Radial, Axial and Mean diffusivity (RD, AD and MD) and fractional anisotropy (FA) were calculated for lesions of the entire brain and the OR. In addition, Gd enhancing lesions were excluded from the analysis.Results86% of chronic T2 lesions demonstrated hypointense areas on T1-weighted images, which typically occupied the central part of each T2 lesion, taking about 40% of lesional volume. The T1-isointense component of the T2 lesion was most commonly seen as a peripheral ring of relatively constant thickness (“T2-rim”). While changes of diffusivity between adjacent normal appearing white matter and the “T2-rim” demonstrated a disproportionally high elevation of RD compare to AD, the increase of water diffusion was largely isointense between the “T2-rim” and T1-hypointense parts of the lesion.ConclusionDistinct patterns of diffusivity within the central and peripheral components of MS lesions suggest that axonal loss dominates in the T1 hypointense core. The effects of de/remyelination may be more readily detected in the “T2-rim”, where there is relative preservation of structural integrity. Identifying and separating those patterns has an important implication for clinical trials of both neuroprotective and, in particular, remyelinating agents.

Quantitative Measurement of tissue damage and recovery within new T2w lesions in pediatric- and adult-onset multiple sclerosis

Background: Children and adolescents with relapsing–remitting multiple sclerosis (RRMS) have a similar T2 lesion burden as adults matched for disease duration. However, it is unknown whether the degree of tissue destruction within lesions is also similar. Persistent reduced T1-weighted signal intensity within lesions indicates loss of tissue integrity. Objective: We aimed to compare change over a 2-year period in T1 intensity within new T2 lesions, from pre-lesion levels to chronic post-lesion levels, between pediatric and adult-onset MS. Methods: A two-point intensity-normalization method was used to generate normalized T1-weighted (NT1) images from T1-weighted data in 29 pediatric MS patients (age(mean±SD, years), disease duration (years)=15.7±2.4, 3.9±2.6) and 24 adult MS patients (36.7±8.9, 6.9±4.8). Subjects were imaged at three consecutive timepoints, 1 year apart. For each subject, a ‘new-T2’ lesion mask was created and the NT1 intensities ‘pre-lesion’, ‘peri-lesion’ and ‘post-lesion’ were determined. A longitudinal model was used to capture NT1 changes. Results: The NT1 in both groups failed to recover to pre-lesion values by 1 year post-lesion (p=0.0002), with children showing significantly better recovery than adults (p=0.0089). Conclusions: Both groups showed a significant chronic reduction of T1 intensity within new T2 lesions. However, children showed a significantly greater recovery of T1 intensity, suggesting that MS lesions in the pediatric MS population are less destructive, or that pediatric patients have greater reparative capacity.

Evaluation of the salivary levels of visfatin, chemerin, and progranulin in periodontal inflammation.

In recent years, adipokines have been reported to play an important role in chronic inflammatory diseases. In this study, our aim was to investigate the salivary levels of visfatin, chemerin, and progranulin and their relationship with periodontal health and disease. A total of 72 patients were included in the study, 23 of which were periodontally healthy, 24 had gingivitis, and 25 had periodontitis. The clinical periodontal parameters including plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment levels (CAL) were recorded. Unstimulated saliva samples were collected, and the concentration of adipokines was evaluated using standard enzyme-linked immunosorbent assay. Salivary visfatin levels were higher in patients with gingivitis and periodontitis compared to those of healthy subjects, while there was no difference between the mean values of gingivitis and periodontitis groups (P > 0.05). There was no difference between the mean values of gingivitis and healthy groups regarding salivary chemerin (P > 0.05), whereas it was detected at higher levels in the periodontitis group compared to the gingivitis and the healthy groups (P < 0.01). Salivary progranulin levels were similar in all groups (P > 0.05). The salivary visfatin level was positively related to PI and GI. The salivary chemerin level was positively related to GI, PD, and CAL. These results demonstrated that the higher levels of chemerin in the saliva of patients with periodontitis were correlated with the degree of tissue destruction. Chemerin may be a novel biomarker in saliva to determine the severity of periodontal disease.

USO DE PRÓPOLIS ASSOCIADA AO MEL E À ALBUMINA EM PÓ NA CICATRIZAÇÃO DE FERIDAS DE PACIENTES COM MIÍASE NECROBIONTÓFAGA - RELATO DE 2 CASOS

Miíase necrobiontófaga ou secundária é causada por larvas de moscas não parasitas obrigatórias que infestam áreas em que há perda de integridade do tegumento, causando grandes devastações, estando a gravidade do quadro dependente da localização da lesão e do grau de destruição do tecido. Demonstramos dois casos clínicos exuberantes de miíase secundária em lesões de solução de continuidade, com sucesso terapêutico, sendo proposto de maneira auxiliar ao tratamento convencional com ivermectina o uso tópico de uma mistura cicatrizante constituída de mel, albumina em pó e própolis.

Differential expression of interferon-γ and chemokine genes distinguishes Rasmussen encephalitis from cortical dysplasia and provides evidence for an early Th1 immune response

BackgroundRasmussen encephalitis (RE) is a rare complex inflammatory disease, primarily seen in young children, that is characterized by severe partial seizures and brain atrophy. Surgery is currently the only effective treatment option. To identify genes specifically associated with the immunopathology in RE, RNA transcripts of genes involved in inflammation and autoimmunity were measured in brain tissue from RE surgeries and compared with those in surgical specimens of cortical dysplasia (CD), a major cause of intractable pediatric epilepsy.MethodsQuantitative polymerase chain reactions measured the relative expression of 84 genes related to inflammation and autoimmunity in 12 RE specimens and in the reference group of 12 CD surgical specimens. Data were analyzed by consensus clustering using the entire dataset, and by pairwise comparison of gene expression levels between the RE and CD cohorts using the Harrell-Davis distribution-free quantile estimator method.ResultsConsensus clustering identified six RE cases that were clearly distinguished from the CD cases and from other RE cases. Pairwise comparison showed that seven mRNAs encoding interferon-γ, CCL5, CCL22, CCL23, CXCL9, CXCL10, and Fas ligand were higher in the RE specimens compared with the CD specimens, whereas the mRNA encoding hypoxanthine-guanine phosphoribosyltransferase was reduced. Interferon-γ, CXCL5, CXCL9 and CXCL10 mRNA levels negatively correlated with time from seizure onset to surgery (P <0.05), whereas CCL23 and Fas ligand transcript levels positively correlated with the degree of tissue destruction and inflammation, respectively (P <0.05), as determined from magnetic resonance imaging (MRI) T2 and FLAIR images. Accumulation of CD4+ lymphocytes in leptomeninges and perivascular spaces was a prominent feature in RE specimens resected within a year of seizure onset.ConclusionsActive disease is characterized by a Th1 immune response that appears to involve both CD8+ and CD4+ T cells. Our findings suggest therapeutic intervention targeting specific chemokine/chemokine receptors may be useful in early stage RE.

Negative pressure wound therapy in acute, contaminated wounds: documenting its safety and efficacy to support current global practice

Negative pressure wound therapy (NPWT) is in widespread use and its role in wound care is expanding worldwide. It is estimated that 300 million acute wounds are treated globally each year. Currently, sporadic data exist to support NPWT in acutely contaminated wounds. Despite lack of data, use of negative pressure wound therapy in such cases is increasing across the globe. We retrospectively reviewed 86 consecutive patients, totalling 97 contaminated wounds. All wounds were Class IV based on US Center for Disease Control criteria. Sepsis criteria were present in 78/86 (91%) of patients. All patients were managed with NPWT. Wound type, degree of tissue destruction, presence of infection, wound dimension, timing of initial NPWT, type and timing of wound closure and patient comorbidities were recorded. Outcome endpoints included durability of wound closure and death. Wound location was 41/97 (42%) in the torso; 56/97 (58%) at the extremities. Tissue necrosis was present in 84/97 (87%) of wounds. Infection was present in 86/97 (89%) of wounds. Average wound size was 619 cm(2) when square surface area measured; 786 cm(3) when volume measurements taken. Mean time to wound closure was 17 days, median 10 days and mode 6 days. Durability of wound closure 73/79 (92%). Deaths were noted in 6/86 (7%) of patients. No deaths appeared related to NPWT. Contemporary NPWT related acute wound care is expanding empirically, in quantity and scope across the globe. However, several areas of concern are known regarding this contemporary use of NPWT in acute wounds. Thus, it is important to assess the safety and efficacy of such expanded empiric NPWT practice. Based on our findings with NPWT in the largest known patient cohort of this type, NPWT appears safe and effective in managing acute, contaminated wounds including patients meeting sepsis criteria. These findings provide evidence-based support for current worldwide empiric NPWT-related acute wound care.

Rickettsia-like organism infection associated with mass mortalities of blood clam, Tegillarca granosa, in the Yueqing Bay in China

A series of mass mortalities of the cultured blood clam, Tegillarca granosa, occurred in the Yueqing Bay of China from 2005 to 2009. An obligate intracellular prokaryote, designated as rickettsia-like organism (RLO), was frequently found in the moribund or dead blood clam sample during ultrastructural examination. These organisms were usually round, ellipsoid or occasionally dumbbell-shaped, ranged from approximately 0.28 to 0.71 µm in size and had a trilaminar cell wall. Two reproductive modes of organisms, transverse binary fission and budding, were observed. The organisms were able to form eosinophilic inclusions. Most inclusions were found within epithelial and connective tissues of the mantle, gills and digestive tube. The biological and morphological characteristics indicate that these organisms may belong to the family Rickettsiaceae. RLOs exhibited significant pathogenicity. Cytopathological examinations revealed extensive necrosis and destruction in the infected cell. The degree of tissue destruction was positively related to the number of RLO inclusions in the tissues, and the cytopathological effects were positively related to the number of intracellular RLO. RLOs and their inclusions were discovered throughout different disease areas and in different time periods. The infection intensity of the RLOs was positively correlated with the mortality rate of clams. Therefore, RLO infection might be associated with mass mortalities of cultured blood clams in the Yueqing Bay.

The Symptoms Get Worse after Pregnancy in Sheehan's Syndrome: A Case Report

Sheehan's syndrome, which is pituitary necrosis after severe postpartum hemorrhage and hypovolemia, may cause hypopituitarism immediately or several years later, depending on the degree of tissue destruction. We report an unusual case, in which a 55-year-old woman with Sheehan's syndrome got worse symptoms after spontaneous labor. In 1998, she had severe postpartum hemorrhage and pituitary necrosis during the third delivery, thus it was diagnosed as Sheehan's syndrome by clinical manifestations, laboratory tests, and magnetic resonance imaging. She was treated by replacement therapy including hydrocortisone and levothyroxine sodium. However, she had the fourth spontaneous pregnancy in 2000 and got worse symptoms after delivery. We carefully concluded that pregnancy provided no evidence against the diagnosis of Sheehan's syndrome because pregnancy might improve hypopituitarism by stimulating the pituitary remnant to undergo hyperplasia and irritating the placenta to secrete hormone. However, pregnancy might aggravate the symptoms by inducing autoimmunity as well. All in all, early diagnosis and adequate medical treatment are important to provide a good prognosis of Sheehan's syndrome.

Infectious granulomatous laryngitis: a retrospective study of 24 cases

The diagnostic and treatment of verrucous lesions of the larynx involves a high level of suspicion by the physician attending the patient. The causes may go from unspecific laryngitis to neoplasia and granulomatous diseases. This kind of lesion is uncommon and the presentation aspects may vary broadly. The lesions in larynx are significant source of morbidity. The onset of symptoms is insidious and the diagnosis is usually delayed. Symptoms include dysphonia, dyspnea, dysphagia and odynophagia. Proper treatment depends upon tissue biopsy, identification of the causative organism, and the appropriate pharmacotherapy. As there are few papers presenting the clinical features of infectious granulomatous laryngitis (IGL) as leishmaniasis, tuberculosis and paracoccidiodomycosis affecting the larynx, we considered important to show the experience of a big Brazilian Laryngology Service in dealing with this potential worldwide problem. We present a retrospective chart review showing our institution's experience with IGL focusing in the diagnostic, treatment and prognosis aspects. Twenty-four patients were identified. Mycobacterium tuberculosis and Paracoccidiodis brasiliensis accounted for ten cases each, and Leishmania braziliensis the remaining four. Hoarseness was the most common symptom of infection. Up to one-third of patients with laryngeal involvement lacked laryngeal symptoms. The average delay from onset of symptoms to diagnosis was 7 months. All patients underwent direct laryngoscopy and biopsies. Caseating granulomas was the key histopathologic finding. Identification of the causative organism was uncommon. No evidence of concomitant malignancy was seen on biopsy. Despite treatment, almost 40% of patients had permanent sequelae of infection, including hoarseness, dyspnea, and dysphagia. Mycobacterium tuberculosis, P. brasiliensis, and L. braziliensis accounted for all cases of IGL. Patients may have laryngeal infection but lack laryngeal symptoms. Prompt diagnosis relies upon a high index of suspicion, especially when evaluating patients from endemic areas. Given the degree of tissue destruction, which accompanies infection, timely intervention may be important in the prevention of late sequelae. Despite appropriate therapy, a significant number of patients may have permanent sequelae of infection.

Role of Cytokines and Chemokines in Pseudomonal Keratitis

Pseudomonal keratitis usually progresses rapidly, often resulting in corneal perforation and blindness. Remarkable events in pseudomonal keratitis include massive polymorphonuclear leukocyte infiltration in the cornea and various degrees of tissue destruction. With regard to initiation of these inflammatory events, various inflammatory cytokines and chemokines appear to be key substances and have been the subject of several studies. Inflammatory cytokines and chemokines believed to be important in pseudomonal keratitis include interleukin (IL)-1 beta, IL-6, macrophage inflammatory protein (MIP)-2 (homologous to human IL-8), macrophage inhibitory factor (MIF), IL-12, IL-18, interferon (IFN)-gamma, and tumor necrosis factor (TNF)-alpha. In this article, current concepts related to the role of inflammatory cytokines and chemokines in pseudomonal keratitis are reviewed.

The Systemic Inflammatory Response to Cardiopulmonary Bypass

The Systemic Inflammatory Response to Cardiopulmonary Bypass