Extensive Edema Research Articles

Posterior reversible encephalopathy syndrome with extensive cytotoxic edema after blood transfusion: a case report and literature review

BackgroundPosterior reversible encephalopathy syndrome (PRES) is described as a clinical-radiological disease entity with good prognosis. In brain MRI, PRES generally presents with vasogenic edema. Although PRES is induced by various causes, a small number of PRES cases have occurred after red cell blood transfusion. It is unclear whether there are characteristic features in PRES after blood transfusion.Case presentationHere, we report a case of 75-year-old Japanese woman who had acute exacerbation of subacute anemia by bleeding from gastric ulcer. After receiving a red cell blood transfusion, she showed disturbance of consciousness with extensive cytotoxic and small vasogenic edema in the occipitoparietal area on brain MRI. She was diagnosed as PRES and suffered irreversible impairments of visual acuity and fields in both eyes. We summarized and discussed clinical features of cases with PRES after blood transfusion.ConclusionsA total of 21 cases including the present one have been reported as PRES after blood transfusion. Of the cases, 20 of 21 were female, and 15 of 17 developed PRES in the course of chronic anemia lasting over 1 month. Anemia was severe in 15 of 20 cases, with hemoglobin levels < 3.5 g/dl. In 14 of 17 cases, hemoglobin levels increased to 5 g/dl by red cell blood transfusion until the onset of PRES. On brain MRI, 2 of 21 cases showed cytotoxic edema and 3 of 21 cases showed irreversible neurological disturbance. In this patient, the occurrence of PRES in subacute anemia and the presence of extensive cytotoxic brain edema with irreversible neurological deficits were characteristic points. When treating severe anemia, even with a subacute progression, we should consider a possibility that PRES occurs after blood transfusion with extensive cytotoxic brain edema and irreversible neurological changes.

Characterization and implications of the dynamics of eosinophils in blood and in the infarcted myocardium after coronary reperfusion.

ObjectiveWe characterized the dynamics of eosinophils in blood and in the infarcted myocardium in patients and in a swine model of reperfused myocardial infarction (MI). The association of eosinophil dynamics with various outcomes was assessed.MethodsSerial eosinophil count and pre-discharge cardiac magnetic resonance were carried out in a prospective series of 620 patients with a first ST-elevation MI. In a swine model of reperfused MI, the dynamics of circulating eosinophils and their presence in the infarcted myocardium were determined. In autopsies from chronic MI patients, eosinophils were quantified.ResultsPatient eosinophil count sharply decreased 12h post-reperfusion compared to arrival. A lower minimum eosinophil count was associated with more extensive edema, microvascular obstruction, and infarct size as measured by cardiac magnetic resonance, and also with a higher rate of cardiac events (death, re-infarction, or heart failure) during follow-up. In the experimental model, eosinophil count boosted during ischemia and dropped back immediately post-reperfusion. Myocardial samples revealed progressive eosinophil migration into the infarcted myocardium, especially areas with microvascular obstruction. Markers of eosinophil maturation and survival (interleukin-5), degranulation (eosinophil cationic protein) and migration (eotoxin-1) were detected in the blood of patients, and in porcine myocardium. Eosinophil infiltration was detected in autopsies from chronic MI patients.ConclusionEosinopenia post-MI was associated with an impaired cardiac structure and adverse events. The decay in circulating eosinophils soon after reperfusion mirrors their migration into the infarcted myocardium, as reflected by their presence in heart samples from swine and patients. Further studies are needed to understanding this unexplored pathway and its therapeutic implications.

Retroperitoneal Teratoma and Ganglioneuroma: A Rare Tumor in a Woman With Gastric Outlet Obstruction

Mature teratomas and ganglioneuromas are rare benign tumors that are found in young female patients. We present a rare case of a complex retroperitoneal mass composed of a teratoma and ganglioneuroma in a young woman with gastrointestinal symptoms. A 28-year-old woman presented with abdominal distension for one year. She complained of intermittent episodes of abdominal bloating and early satiety, which was relieved by fasting. She had frequent nausea and vomiting of partly digested food. She reported a 20 pound weight loss. She had no significant past medical history and denied using alcohol or any recreational drugs. On initial assessment patient had stable vital signs. Physical examination was notable for tympanic abdomen and diminished bowel sounds. Laboratory studies revealed hemoglobin of 9.7gm/dl with MCV of 85.3, normal comprehensive metabolic panel and a negative beta-HCG. CT abdomen was done and revealed a markedly distended stomach and a hypodense para-aortic retroperitoneal heterogeneous mass in the proximity of the stomach and the left adrenal gland encasing the celiac axis and superior mesenteric artery. Nasogastric tube was inserted and provided immediate relief of symptoms. EGD was performed and showed pyloric stenosis and a large duodenal bulb ulcer with extensive duodenal edema. EUS showed a hypoechoic mass near the gastric body. FNA sampling was non diagnostic. Stomach biopsies were positive for H. pylori. After discussion with the surgery team, patient was taken for an open biopsy. A large well-encapsulated para-aortic mass was visualized and completely resected. Duodenum was found to be extremely thick and strictured, therefore a gastrojejunostomy was additionally performed. Biopsy of the mass revealed components of mature cystic teratoma and ganglioneuroma. Patient did well postoperatively and was discharged home to complete H. Pylori treatment. Teratomas contain cell types derived from one or more of the three germ cell layers. Ganglioneuromas are benign tumors composed entirely of ganglion cells and found along sympathetic nerve plexus. These tumors can cause symptoms, such as gastric obstruction, when they compress surrounding organs. It is extremely rare to find teratomas and ganglioneuromas within same mass structure. Treatment of both teratoma and ganglioneuroma tumors is surgical resection. Some experts recommend periodic radiologic surveillance due to potential metastatic potential of these tumors.2617 Figure 1. CT scan of the retroperitoneal mass in paraaortic region

Colonic Ischemia: A Rare Occurrence Following Vaginal Delivery

Ischemic colitis is a type of intestinal ischemia typically associated with vasculopathy in advanced age. While some predisposing factors can increase the risk of disease, ischemic colitis is uncommon in young adults. Furthermore, cases of ischemic colitis associated with pregnancy are exceedingly rare. We present a case of ischemic colitis in a young woman following vaginal delivery that ultimately led to sigmoid resection due to persistent stricturing. A 29-year-old female with chronic HCV infection from past IVDU underwent a vacuum-assisted vaginal delivery of a term pregnancy. Following delivery, she developed severe LLQ abdominal pain and bloody diarrhea. Flexible sigmoidoscopy on postpartum day 1 found dark discoloration and extensive mucosal edema of the left colon suggestive of ischemia. Histology revealed active colitis with ulcerative debris and gland dropout. After ruling out other potential causes, she was diagnosed with acute ischemic colitis and treated conservatively. The patient eventually left the hospital in stable condition, but she continued to experience symptoms in the weeks following discharge. Surveillance colonoscopy later revealed a tight stricture in the sigmoid colon that had formed because of recent ischemia. Efforts to dilate and traverse the stricture endoscopically were unsuccessful. The patient was referred to colorectal surgery and underwent a laparoscopic sigmoid colectomy. Gross pathology of the surgical specimen showed ulceration, inflamed granulation tissue, and glandular disarray consistent with ischemia and chronic colitis. A month after her surgery, the patient was seen in the office and was reported to be doing well. Reports of ischemic colitis associated with pregnancy in the literature are scarce and limited clinical data has made it difficult to definitively establish the underlying pathophysiology. Based on several documented cases of transient ischemic colitis in women taking oral contraceptives, current literature suggests that an estrogen-induced hypercoagulable state may play a role. The same underlying mechanism links excess estrogen from oral contraceptives with a risk of forming thromboemboli. Whether this mechanism was the cause in our case remains unclear. Physicians should be mindful of the physiologic changes that occur during pregnancy. And although it is rare, ischemic colitis should be considered in the differential when treating pregnant patients who complain of abdominal pain and bloody diarrhea.

FROM A SIMPLE COLD SORE TO SEVERE CYSTIC LUNG DISEASE

SESSION TITLE: Chest Infections 2 SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Necrotizing fasciitis, septic embolic, and tension pneumothorax are all individually a cause of significant morbidity and mortality. When combined, they pose a significant treatment dilemma, as options in critically ill patients are limited. Here we present a case of a cold sore leading to multiple pneumothoraces from septic emboli causing severe cystic lung disease. CASE PRESENTATION: A 57-year-old healthy male presented with fever, facial swelling, and dyspnea. He reported a cold sore lesion that rapidly progressed into right facial and neck swelling. A CT of the head and neck showed extensive edema involving the facial plane extending to the parapharyngeal space suggestive of necrotizing fasciitis. He underwent emergent debridement in the operating room, blood and wound cultures grew methicillin sensitive S.aureus. His course progressed to hypoxic respiratory failure complicated by a spontaneous tension pneumothorax (PTX) requiring chest tube placement. Despite lung protective ventilation he developed diffuse cystic lung lesions and moderate bilateral loculated PTXs with tension physiology that led to cardiac arrest. He was ultimately revived, however required seven chest tubes, each with persistent air leaks. Pleurodesis or surgical/endoscopic procedures were not attempted, as he was too unstable. During the course of 2 months, he was maintained on mechanical ventilation via tracheostomy, IV antibiotics, and dialysis. As he gradually improved he was weaned from mechanical ventilation, allowing his air leaks to resolve and his chest tubes removed. DISCUSSION: A tension pneumothorax secondary to septic emboli is a rare yet possibly fatal disease. Here we present a case of necrotizing fasciitis from a simple cold sore progressing to multiple pulmonary septic emboli. This led to severe cystic lung disease from the multiple loculated and tension pneumothoraces. Multiple pneumothoraces with persistent air leaks posed a significant challenge to management, where preferred treatment is surgical repair. These air leaks make ventilation and oxygenation incredibly difficult, leading the inability to wean from the ventilator. Such critically ill patients are too high risk for surgical intervention, however this case demonstrates where conservative management led to the patients ultimate recovery. Endobronchial valves may still be promising in such dilemmas shown by recent observational studies. However there are no controlled studies to compare these new approaches, and therefore the clinician’s best judgment must be used. CONCLUSIONS: Diffuse cystic lung diseases (DCLD) present from varying pathophysiologic mechanisms. DCLD do not have a homogenous distribution, but they do share pneumothoraces. Management with positive pressure ventilation was cumbersome in this patient when the risk for recurrence remains high past this hospitalization. Reference #1: Okabe M, Kasai K, Yokoo T. Pneumothorax Secondary to Septic Pulmonary Emboli in a Long-term Hemodialysis Patient with Psoas Abscess. Internal Medicine. 2017;56(23):3243-3247. https://doi.org/10.2169/internalmedicine.9050-17. Reference #2: Cystic Lung Diseases: Algorithmic Approach. Raoof S., Bondalapati P., Vydyula R., Ryu J.H., Gupta N., Raoof S., Galvin J., (…), Naidich D. (2016) Chest, 150 (4) , pp. 945-965. DISCLOSURES: No relevant relationships by Hassan Al Khalisy, source=Web Response no disclosure on file for Ioana Amzuta; No relevant relationships by Marsha Antoine, source=Web Response No relevant relationships by Ritu Modi, source=Web Response No relevant relationships by Bashar Sharma, source=Web Response

Actinomyces-Induced Esophageal Stricture in an Immunocompetent Host

Actinomyces is an anaerobic organism that resides in the GI tract and is a rare cause of esophageal stricture, usually in immunocompromised patients. We present an immunocompetent patient with chronic dysphagia whom we found to have an esophageal stricture growing Actinomyces. A 44 year-old Haitian woman with no past medical history was admitted for 6 months of dysphagia to both solids and liquids that later progressed to odynophagia. She also complained of fatigue, weakness, and 15 lb weight loss. She denied having nausea, vomiting, abdominal pain, or substernal burning. Our initial EGD showed an esophageal stricture 15 cm from the incisors that was too narrow for the scope to pass (Fig. 1). Biopsies at the site showed ulceration with granulation tissue and clusters of Actinomyces. Brush cytology was negative for malignancy. Dilation was deferred due to extensive edema and friability. A follow-up barium esophagram confirmed the stricture was 2cm long (Fig. 2). She was started on IV penicillin G. Our repeat EGD six weeks later showed resolution of the swelling (Fig. 3) and subsequent video fluoroscopy showed 50% luminal narrowing over a 5-6 cm segment. We then scheduled the patient for balloon dilatation, which was successful, and six more months of antibiotics, which are ongoing.1726_A Figure 1. Initial EGD Finding1726_B Figure 2. Esophagram Findings1726_C Figure 3. Post-Treatment EGD FindingsActinomyces typically resides in the GI and genitourinary tracts, but can become pathogenic upon breaching the mucosal barrier. Commonly affected groups include men, diabetics, and the immunosuppressed. It will generally present with odynophagia, dysphagia, and weight loss. Initial work-up includes neck CT and barium studies, but definitive diagnosis is via tissue biopsy. Fewer than 30 cases of esophageal Actinomyces have been reported and only 9 involved immunocompetent hosts. Factors such as trauma, surgery, malignancy, chemotherapy, and radiation therapy may increase risk of pathogenesis. Esophageal dysmotility from hiatal hernias is another potential mechanism for infection in immunocompetent hosts since acid reflux can damage the mucosa and lead to invasion. Strictures causing dysphagia can be treated with mechanical dilatation, and any infection must be treated with beta-lactam antibiotics. There have been no reported incidents of recurrent symptoms in immunocompetent hosts following treatment.

A novel form of intracranial coccidioidomycosis is present in dogs and exhibits characteristic clinical and magnetic resonance imaging findings

The neurological examination findings, clinical pathology (including Coccidioides immitis IgG/IgM serology) and magnetic resonance imaging (MRI) findings in 13 dogs with a novel form of intracranial coccidioidomycosis are described in a retrospective case series, with long-term clinical resolution documented in 11/13 dogs (84.6% of cases) with oral fluconazole therapy. The medical records of the Veterinary Neurological Center in Phoenix, Arizona from the years 2000 to 2017 were utilized to search for dogs with appropriate inclusion criteria. Magnetic resonance imaging findings were highly consistent across all cases and characteristically demonstrated bilaterally symmetric T2 hyperintensity throughout the frontal lobes, caudate nuclei, and rostral internal capsule, ±faint, wispy contrast enhancement on T1-postcontrast images. These findings were in stark contrast to previously reported MRI findings in dogs with intracranial coccidioidomycosis, which were typically characterized by a focal, strongly contrast enhancing granuloma and extensive vasogenic edema, typically unilateral. Schnauzer breeds represented eight of 13 (61.5%) cases, possibly suggesting a breed predilection. Three cases underwent repeat MRI after resolution of neurological signs and documentation of a decreased Coccidioides titer in response to fluconazole therapy. All demonstrated complete resolution of previously identified lesions, but with marked, severe atrophy of the caudate nuclei and frontal lobes bilaterally. Findings from this study document a variant appearance for intracranial coccidioidomycosis that, to the author's knowledge, has not been previously described in dogs. Authors propose that, although this variant demonstrates extensive pathological changes within the forebrain, the clinical outcome and response to treatment is favorable in a majority of cases.

Cataract couching and the goat's eye.

At the start of the third century, a story told by Claudius Aelianus, Leonidas of Alexandria and pseudo-Galen held that couching originated when a goat with cataract punctured its eye with a thorn. The significance of this story is unknown. We reviewed Graeco-Roman texts to identify the relevance of the goat to the eye. In the works of Hippocrates, Aristotle and Galen, the goat's eye was an eye with intermediate brightness or colour. A dark brown eye with a black pupil was healthy and required no treatment. A bright glaukos eye, with extensive corneal edema or scarring, was not amenable to couching. An eye with a white cataract behind an undilated pupil would appear to have an intermediate brightness and was potentially amenable to couching. The origin myth probably arose when an instructor explained that couching works best for a goat's eye, that is, an eye with intermediate brightness.

Cranioplasty using Polymethylmethacrylate (PMMA) self-curing by the conventional casting process: clinical case report

ABSTRACT Cranioencephalic trauma which results in extensive edema and / or bruising usually requires surgical treatment through a greater withdrawal of the bone portion. Thus, the absence of bone tissue implies the lack of protection of the brain tissue or even compromises the esthetics especially when located in the frontal or frontoparietal region. The purpose of this case report is to describe a treatment option for head trauma, through the prefabricated part by obtaining the skull model. These bone faults can be reconstructed either by the direct method using polymethylmethacrylate directly on the defects or by means of pre-made pieces such as prototyping or from the skull model. Although other techniques have many good points, some show certain drawbacks, from storage conditions below abdominal fat, preheating due to the release of heat during the high polymerization reaction or the high cost when they are prototyped. The technique described in this work reports its simple performance, eliminating the risk of local heating, allows prior sterilization in autoclave, it is biocompatible, allows perfect anatomical recovery, easy placement, low cost, also highlighs the advantage of the bucomaxillofacial surgeon's performance due to the familiarization with the relevant head and neck procedures. Clinical and tomographic examination after 24 months of treatment showed stability of the polymethylmethacrylate plate, adhesions to the bone margins, and absence of tissue alterations.

PS01.078: AN UNUSUAL PRESENTATION OF BOERHAAVE SYNDROME

Abstract Background Oesophageal perforations are rare but potentially lethal. Boerhaave syndrome classically results in a longitudinal oesophageal perforation at the left posterolateral distal oesophagus. We present an unusual case with cervical oesophageal mucosal perforation and submucosal dissection. Methods We review our patient—a 53 year old lady, Mdm S, who presented after 4 days of vomiting with sepsis and diabetic ketoacidosis. CT thorax scan showed extensive long segment circumferential mural thickening and oedema of the entire oesophagus, extensive pneumotosis of the proximal half, and a focal mucosal discontinuitiy of the cervical oesophagus. There were also pneumomediastinum, fat stranding in the superior mediastinum, and a right pleural effusion. Results Gastroscopy and surgical exploration of the right hemithorax and neck identified a 2cm linear cervical oesophageal mucosal defect. There was no muscular perforation; an air leak test did not demonstrate a transmural perforation. Copious lavage of the mediastinum and right thoracic cavity were performed and large bore drains were placed in the neck, right thoracic cavity and superior mediastinum. A venting gastrostomy and a feeding jejunostomy were also created. Mdm S’s recovery was complicated by a persistent right pneumothorax. An interval gastroscopy revealed a line of interrupted longitudinal oesphageal mucosal defects starting at 18cm to 31 cm from the incisors. The submucosal space had opened up for the same length, and the scope easily entered the submucosal plane, where a muscle wall defect was detected at 18cm from the incisors. Conclusion Cervical oesophagus is an unusual site of Boerhaave's perforation. While the initial perforation was not transmural, surgical lavage and drainage were essential for sepsis control. Subsequent recovery was achieved by following principles of fistula management- diversion of gastrointestinal contents, drainage of oesophageal leak to control sepsis, optimisation of nutrition via a feeding jejunostomy. Disclosure All authors have declared no conflicts of interest.

Combined aspiration thrombectomy and continuous intrasinus thrombolysis for cerebral venous sinus thrombosis: technical note and case series.

Cerebral venous sinus thrombosis is an uncommon cause of stroke with high morbidity and mortality rates from venous infarction, intracranial hemorrhage, and extensive cerebral edema. Endovascular treatment with various devices has been proposed as a salvage treatment when standard medical treatment with systemic anticoagulation is ineffective, especially in long segment dural sinus thrombosis. We describe our technique of transvenous endovascular aspiration thrombectomy with large bore thrombectomy catheters, followed by placement of microcatheter for local thrombolytic infusion at the site of thrombosis. We report a retrospective study of angiographic and clinical outcome of six consecutive patients treated with this approach. Endovascular aspiration thrombectomy with large bore catheters followed by continuous local thrombolytic infusion appeared to be a safe and effective salvage treatment for selected patients with cerebral dural venous sinus thrombosis refractory to medical treatment.

Venom fromBothrops lanceolatus, a Snake Species Native to Martinique, Potently Activates the Complement System

Bothrops lanceolatus snake venom causes systemic thrombotic syndrome but also local inflammation involving extensive oedema, pain, and haemorrhage. Systemic thrombotic syndrome may lead to fatal pulmonary embolism and myocardial and cerebral infarction. Here, we investigated the ability of B. lanceolatus venom to activate the Complement system (C) in order to improve the understanding of venom-induced local inflammation. Data presented show that B. lanceolatus venom is able to activate all C-pathways. In human serum, the venom strongly induced the generation of anaphylatoxins, such as C5a and C4a, and the Terminal Complement complex. The venom also induced cleavage of purified human components C3, C4, and C5, with the production of biologically active C5a. Furthermore, the venom enzymatically inactivated the soluble C-regulator and the C1-inhibitor (C1-INH), and significantly increased the expression of bound C-regulators, such as MCP and CD59, on the endothelial cell membrane. Our observations that B. lanceolatus venom activates the three Complement activation pathways, resulting in anaphylatoxins generation, may suggest that this could play an important role in local inflammatory reaction and systemic thrombosis caused by the venom. Inactivation of C1-INH, which is also an important inhibitor of several coagulation proteins, may also contribute to inflammation and thrombosis. Thus, further in vivo studies may support the idea that therapeutic management of systemic B. lanceolatus envenomation could include the use of Complement inhibitors as adjunct therapy.

Longitudinally extensive vasogenic edema following spinal cord infarction

AbstractAlthough transient lesion expansion has been reported after spinal cord infarction, longitudinally extensive lesion expanding more than several vertebral segments is extremely rare. We report a 45‐year‐old man having spinal cord infarction with subsequent longitudinally extensive lesion expansion on magnetic resonance imaging (MRI) 10 days after the infarction. The length of T2 hyperintense lesion was four vertebral segments on initial MRI but enlarged to span 12 vertebral segments on subsequent MRI, with Lhermitte's sign, but otherwise without neurological deterioration. The expanded lesion extended beyond the anterior spinal artery region with high apparent diffusion coefficient value in the acute phase but improved within 10 days after starting cervical collar, suggesting that lesion expansion was due to vasogenic edema. This case illustrates that transient longitudinal lesion expansion accompanied by spinal cord infarction can reach lengths of up to 12 vertebral segments. Caution should be exercised while interpreting MRI findings to avoid excessive treatment or secondary damage.

Mural destabilization after aneurysm treatment with a flow-diverting device: a report of two cases

BackgroundFlow-diverting stents have demonstrated great promise for the treatment of cerebral aneurysms; however, clinical experience with the devices remains very preliminary. We present two cases of spontaneous delayed complications—one fatal...

Sclerosing Ovarian Tumor with Disrupted Morphology: Significance of Ancillary Tests in Resolving Diagnostic Dilemma

AbstractSclerosing stromal tumor is an uncommon subtype of sex cord–stromal tumor of the ovary. It occurs in young females who present with pelvic pain and menstrual irregularities. We present a case of an 18-year-old female who was brought to emergency room with a history of blunt trauma abdomen after road traffic accident. A diagnosis of hemoperitoneum was made, and the patient underwent emergency exploratory laparotomy. An incidental right ovarian mass was found which was removed and sent for histopathological examination. Histomorphology of this lesion showed variable findings with extensive edema and paucicellularity. Few thin wall blood vessels were also observed. The possible differential diagnosis on gross and microscopic examination included sclerosing stromal tumor, fibroma, thecomas, granulosa cell tumor, and edema of the ovary. In view of diagnostic dilemma, special stains for collagen and reticulin were done. In addition, immunohistochemistry (IHC) for CD99, smooth muscle actin, and desmin was put up. A diagnosis of sclerosing tumor of the ovary was made based on histomorphology and findings of ancillary tests. In general, ancillary tests are not required to diagnose sclerosing ovarian tumor as it has characteristic histological features. This case highlights the usefulness of special stains and IHC in sex cord tumors with overlapping microscopic features.

MiR-155 deletion reduces ischemia-induced paralysis in an aortic aneurysm repair mouse model: Utility of immunohistochemistry and histopathology in understanding etiology of spinal cord paralysis.

Spinal cord paralysis is relatively common after surgical repair of thoraco-abdominal aortic aneurysm (TAAA) and its etiology is unknown. The present study was designed to examine the histopathology of the disease and investigate whether miR-155 ablation would reduce spinal cord ischemic damage and delayed hindlimb paralysis induced by aortic cross-clamping (ACC) in our mouse model. The loss of locomotor function in ACC-paralyzed mice correlated with the presence of extensive gray matter damage and central cord edema, with minimal white matter histopathology. qRTPCR and Western blotting showed that the spinal cords of wild-type ACC mice that escaped paralysis showed lower miR-155 expression and higher levels of transcripts encoding Mfsd2a, which is implicated in the maintenance of blood-brain barrier integrity. In situ based testing demonstrated that increased miR-155 detection in neurons was highly correlated with the gray matter damage and the loss of one of its targets, Mfsd2a, could serve as a good biomarker of the endothelial cell damage. In vitro, we demonstrated that miR-155 targeted Mfsd2a in endothelial cells and motoneurons and increased endothelial cell permeability. Finally, miR-155 ablation slowed the progression of central cord edema, and reduced the incidence of paralysis by 40%. In sum, the surgical pathology findings clearly indicated that the epicenter of the ischemic-induced paralysis was the gray matter and that endothelial cell damage correlated to Mfsd2a loss is a good biomarker of the disease. MiR-155 targeting therefore offers new therapeutic opportunity for edema caused by traumatic spinal cord injury and diagnostic pathologists, by using immunohistochemistry, can clarify if this mechanism also is important in other ischemic diseases of the CNS, including stroke.

Bone marrow edema in traumatic vertebral compression fractures: Diagnostic accuracy of dual-layer detector CT using calcium suppressed images

PurposeTo evaluate calcium suppressed images (CaSupp) in dual-layer detector computed tomography (DLCT) for the detection of bone marrow edema (BME) in vertebral fractures. Materials and methodsThe retrospective study was approved by the institutional review board. 34 patients with synchronous DLCT and MRI, who were diagnosed with one or more acute vertebral fractures, were included. MRI were systematically analyzed as reference standard. Two blinded and independent readers evaluated CaSupp for vertebral BME. Additionally, both readers determined the optimal calcium suppression indices (CaSupp-I) for visualization of BME in consensus and correlated the CaSupp-I with parallel measurement of trabecular density as surrogate parameter for bone mineral density. ROI-based measurements of the contrast-to-noise ratios (CNR) were also conducted. Interrater agreement was determined by kappa-statistics. CNR were analyzed using Wilcoxon signed rank test. ResultsFifty-seven acute fractured vertebrae out of 383 vertebrae (14.9%) were found. CaSupp yielded an average sensitivity of 87% and specificity of 99%, a positive predictive value of 95%, a negative predictive value of 98% and an accuracy of 97% for the detection of fracture-associated edema. Interrater agreement was excellent (kappa 0.91). Increase in CNR of BME correlated with increasing CaSupp-I. Edema adjacent to the cortical endplates was better visualized using CaSupp-I of 70 and 80, while extensive edema was better visualized using a CaSupp-I of 90 and 100 (chi2 < 0.0001). No correlation between optimal CaSupp-I and trabecular density was found (p > 0.2). ConclusionCaSupp reconstructed from DLCT enable visualization and detection of BME in traumatic fractured vertebrae with high diagnostic accuracy using CaSupp-I of 70–100.

Hsp70 Suppresses Mitochondrial Reactive Oxygen Species and Preserves Pulmonary Microvascular Barrier Integrity Following Exposure to Bacterial Toxins.

Pneumonia is a leading cause of death in children and the elderly worldwide, accounting for 15% of all deaths of children under 5 years old. Streptococcus pneumoniae is a common and aggressive cause of pneumonia and can also contribute to meningitis and sepsis. Despite the widespread use of antibiotics, mortality rates for pneumonia remain unacceptably high in part due to the release of bacterial toxins. Pneumolysin (PLY) is a cholesterol-dependent toxin that is produced by Streptococcus, and it is both necessary and sufficient for the development of the extensive pulmonary permeability edema that underlies acute lung injury. The mechanisms by which PLY disrupts the pulmonary endothelial barrier are not fully understood. Previously, we found that reactive oxygen species (ROS) contribute to the barrier destructive effects of PLY and identified an unexpected but potent role of Hsp70 in suppressing ROS production. The ability of Hsp70 to influence PLY-induced barrier dysfunction is not yet described, and the goal of the current study was to identify whether Hsp70 upregulation is an effective strategy to protect the lung microvascular endothelial barrier from G+ bacterial toxins. Overexpression of Hsp70 via adenovirus-mediated gene transfer attenuated PLY-induced increases in permeability in human lung microvascular endothelial cells (HLMVEC) with no evidence of cytotoxicity. To adopt a more translational approach, we employed a pharmacological approach using geranylgeranylacetone (GGA) to acutely upregulate endogenous Hsp70 expression. Following acute treatment (6 h) with GGA, HLMVECs exposed to PLY displayed improved cell viability and enhanced endothelial barrier function as measured by both Electric Cell-substrate Impedance Sensing (ECIS) and transwell permeability assays compared to control treated cells. PLY promoted increased mitochondrial ROS, decreased mitochondrial oxygen consumption, and increased caspase 3 cleavage and cell death, which were collectively improved in cells pretreated with GGA. In mice, IP pretreatment with GGA 24 h prior to IT administration of PLY resulted in significantly less Evans Blue Dye extravasation compared to vehicle, indicating preserved endothelial barrier integrity and suggesting that the acute upregulation of Hsp70 may be an effective therapeutic approach in the treatment of lung injury associated with pneumonia.

Severe extensive ecchymotic oedema in the buttock.

Journal of Paediatrics and Child HealthVolume 54, Issue 5 p. 588-588 Images of the Month Severe extensive ecchymotic oedema in the buttock First published: 13 May 2018 https://doi.org/10.1111/jpc.2_13887Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume54, Issue5May 2018Pages 588-588 RelatedInformation

Severe extensive ecchymotic oedema in the buttock.

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