Changes in S100β protein levels in cerebrospinal fluid after thoracoabdominal aortic operations

AbstractJ Thorac Cardiovasc Surg 2001;122:1019-2

Arterio-jugular Differences in Serum S-100β Proteins in Patients Receiving Selective Cerebral Perfusion

Purpose The early increase in serum S100β after cardiopulmonary bypass (CPB) seems to be derived from an extracerebral source. To exclude contamination, we investigated the arterio-jugular differences in S100β levels in patients receiving selective cerebral perfusion (SCP). We also evaluated the brain-protective effect of SCP by comparing the arterial S100β levels with those in patients undergoing coronary artery bypass grafting (CABG). Methods We measured arterial and jugular venous levels of S100β in ten patients undergoing aortic arch repair with SCP for up to 12h postoperatively (SCP group). We also measured arterial levels of S100β in nine patients undergoing CABG (CPB group). Results There was no incidence of hospital death or stroke. The arterial levels of S100β in both groups were comparable and peaked just after the conclusion of CPB. The arterial and jugular venous levels of S100β were almost equivalent. The arterio-jugular differences in S100β levels were negligible, even in our SCP-group patient with postoperative delirium, who had a peak value three times higher than the other patients. Conclusions The arterio-jugular differences in S100β did not clarify the origin of their increase. Thus, measuring the jugular venous levels of S100β in patients without postoperative clinical neurological deterioration would be of little benefit. However, SCP seems to protect the brain against S100β release as effectively as conventional CPB

A semiquantitative analysis of reactive astrogliosis demonstrates its correlation with the number of intact motor neurons after transient spinal cord ischemia

ObjectiveWe evaluated the relationship between reactive astrogliosis and delayed motor neuron death after transient spinal cord ischemia in rabbits using a semiquantitative analysis of glial fibrillary acidic protein expression.MethodsSpinal cord ischemia was induced by means of balloon occlusion of the infrarenal aorta for 15 minutes at 39°C in 18 New Zealand white rabbits. At 1, 3, and 7 days after reperfusion, 6 animals at each time point were killed, and the spinal cord was removed for histologic and immunohistochemical study. The variables analyzed were (1) neurologic function (Johnson score) at every 24 hours after reperfusion, (2) the number of intact motor neurons and terminal deoxynucleotidyl transferase–mediated deoxyuridine triphosphate-biotin nick-end labeling–positive positive neurons, and (3) expression of glial fibrillary acidic protein in the gray and white matter, which was expressed as the percentage of stained area.ResultsAll animals presented delayed motor neuron death. The number of intact neurons decreased correlatively with neurologic function. No obvious terminal deoxynucleotidyl transferase–mediated deoxyuridine triphosphate-biotin nick-end labeling–positive cells were observed. Glial fibrillary acidic protein expression increased with time in both the gray and white matter, representing the development of reactive astrogliosis. Significant correlation was found between glial fibrillary acidic protein expression and the number of intact motor neurons on the third day in both the gray (r2 = 0.726, P = .031) and white (r2 = 0.927, P = .002) matter.ConclusionsReactive astrogliosis 3 days after transient spinal cord ischemia correlates with the number of intact motor neurons. Our method for semiquantitative analysis of reactive astrogliosis is simple and reproducible and seems useful for such experimental studies

Spontaneous perigraft hematoma suggesting transgraft hemorrhage seven years after thoracic aortic replacement with a Dacron graft

As a previously unrecognized late graft-related complication, we report a case of spontaneous perigraft hemorrhage, which was evidenced by contrast extravasation on computed tomographic scan seven years after thoracic aortic replacement with a knitted Dacron graft. There was no anastomotic problem or graft tear, and the hematoma seemed to result from transgraft hemorrhage. Inadequate graft healing and use of a knitted graft in the thoracic aorta seem underlying. Surgeons should be aware of this complication and we advocate careful long-term follow-up

8th Edition Tumor, Node, and Metastasis T-Stage Prognosis Discrepancies: Solid Component Diameter Predicts Prognosis Better than Invasive Component Diameter

The biggest change in the 8th edition of the tumor, lymph node, and metastasis (TNM) classification is the recommendation of the solid component diameter and invasive size for determining the clinical and pathological T-factor, respectively. Here, we validated new proposals for the Lung Cancer TNM classification’s revision and compared clinical and pathological T-stages. We retrospectively analyzed 177 cases of non-small cell lung cancers without lymph node metastasis, and involving complete resection, that occurred in our department between January 2017 and March 2019. We reviewed the overall tumor diameter, solid component diameter, and clinical T-factor on computed tomography (CT), and the pathological tumor diameter, pathological invasion diameter, pathological T-factor, and prognosis. The difference between the pathological invasive size and solid size on CT was within 5 mm in 99 cases (56%). At a two-year recurrence-free survival rate, the clinical T-stage demonstrated a better prognostic outcome than the pathological T-stage. Despite including the benign findings, the solid component diameter was better correlated with prognosis than the invasive size. Therefore, in cases of discrepancies of clinically and pathologically detected tumor size, the solid CT size should also be used for the pathological T classification

Single-Incision Laparoscopic Surgery for Intersigmoid Hernia

Intersigmoid hernia is a rare form of internal hernia. Here, we report a case of intersigmoid hernia and provide a brief review of the 62 cases involving the mesosigmoid reported in Japan from 2000 to 2013. In the current case, a 26-year-old man with no previous history of abdominal surgery presented with abdominal pain and vomiting. Abdominal computed tomography revealed an extensively dilated small bowel and a closed loop of small bowel in the mesosigmoid. The patient was diagnosed with an intestinal obstruction due to an incarcerated internal hernia involving the mesosigmoid. There was no blood flow obstruction at the incarcerated bowel. An elective single-incision laparoscopic surgery was performed after decompression of the bowel using ileus tube. As the ileum herniated into the intersigmoid fossa, the patient was diagnosed with an intersigmoid hernia. The incarcerated small bowel was reduced in order to make it viable, and the hernial defect was closed with interrupted sutures. The patient had an uneventful recovery and was discharged on postoperative day five