Experimentelle Untersuchungen über die Ursachen der akuten Pankreasnekrose. (IV. Mitteilung) Experimentelle und klinische Studien über die Abfliessung von Pankreassaft in die Gallenwege

Clairmont und v. Haberer beobachten 1910 einen Fall, der das Sypmtom akuter Peritonitis mit galligem Exsudate darbot. Da bei der Obduktion keine Perforation an den Gallenwegen zu finden war, belegten sie diesen Fall mit dem Namen "perforationslose gallige Peritonitis". Anschliessend an diese Veröffentlichung wurden im Laufe der Jahre eine grosse Anzahl analoger Fälle beschrieben und es entspann sich eine so lebhafte Diskussion über den Entstehungsmechanismus dieser Krankheit, dass eine Einigung daruber noch lange nicht zu erwarten ist. Seitdem aber A. Blad 1918 eine neue Theorie der Pankreassaftstauung für die Erklärung dieser Frage aufgestellt hatte, wurde seine Annahme von Schönbauer, Westphal u.a. in Bezug auf die Pankreasfermente nachgeprüft und man konnte dabei durch Einführung der Pankreasfermente nicht nur eine Verdauungsnekrose der Gallenblasenwand hervorrufen, sondern in einigen Fällen sogar die perforationslose gallige Peritonitis erzeugen. Ferner haben Gundermann, Westphal, Ruppanner, Dziembowsky, Brackerg, Popper u.a. in der Gallenblasengalle eine abnorme Vermehrung von Diastase nachweisen. Der Erscheinungsmechanismus der Pankreasfermente in der Galle ist jedoch von den verschiedenen Beobachtern verschieden festgestellt und gedeutet worden. Während einige Forscher annehmen, dass die Diastase von der Leber abgesondert wird, wird sie von anderen in die Blut- oder Lymphwege eingebracht. Wieder andere betonen sogar die Möglichkeit der Abfliessung des Pankreassaftes in die Gallenwege. Ich habe nur zur Feststellung der Wirkungen, die der Pankrassaft auf die Gallenwege und vor allem auf die Gallenblase ausübt, bei einer Gruppe der Versuchstiere experimentell die Gallenblase an ihrem Hals unterbunden, bei einer anderen eine Ligatur an den Ductus choledochus angelegt und dann den beiden Gruppen je ein Präparat von Pankreassekret resp. Pankreasfermenten eingeführt. Daneben habe ich auch den Versuch ausgeführt, den Ductus pancreaticus mit der Gallenblase in Kommunikation zu bringen. Ferner habe ich bei 35 Patienten, die wegen Gallensteinkrankheit in unsere Tsuda-Klinik aufgenommen worden waren, in der durch eine Punktion intra operationem gewonnenen Galle den Diastasewert bestimmt und auch die in der Galle der Gallenfistel befindlichen Pankreasfermente fraktionierend untersucht. Bei Versuchshunden habe ich sodann die akute Pankreasnekrose hervorgerufen und die im Blutserum sowohl wie in der Galle befindliche. Diastase fraktionierend aufgefangen und an beiden Diastasen ergleichende Untersuchung angestellt. Am Ende werde ich noch uber einen interessanten klinischen Fall berichten, in dem der Anfall der akuten Pankreasnekrose bei einem Gallensteinkranken wiederholend aufgetreten war. Meine Ergebnisse waren wie folgende: 1. Fälle, in denen die Pankreasfermente nach operativem Cysticusverschluss in die Gallenblase eingeführt wurden. a) Bei der Einführung physiologischer Kochsalzlösung wurden ausser einer Dilatation der Gallenblasenwand keine histologischen Veaänderungen beobachtet. b) Bei der Einführung von 5% Protamylaselösung in der Dosis von 1-5cc entstand in 1/3 der sämtlichen 11 Fälle perforationslose gallige Peritonitis. Histologisch liess sich bis zu 65% eine vollige Nekrose aller Schichten nachweisen. Ausserdem wurden in der Mehrzahl der Fälle Blutungen und Zellinfiltrationen festgestellt. c) Bei der Einfuhrung von 10-40% Diastaselösung in der Dosis von 2cc wurde die Gallenblase in der Regel am leichtesten geschädigt, indem ein Peritonealexsudat in keinem Fall beobachtet wurde und nur Blutungen und Zellinfiltrationen in die Erscheinung traten

On the Design and Development of a Zigbee-Based Multimodal Input-Output Monitoring-Actuating System

The monitoring of a physically challenged patient’s activities is a crucial and difficult task for the medical professionals. The design and development of a multimodal- input and output wireless system with two sensors and three actuators that can be used for just monitoring or for both monitoring and stimulating are discussed in this research. Touch and tilt sensors at the input part of the system attached to Zigbee modules communicate in a wireless manner with voice, vibration and light actuators connected to Zigbee modules at the output part. The hardware and the software parts are designed and integrated in such a way that a new sensor at the input or a new actuator at the output can be included or excluded based on the needs of the patient. It is shown how to design and develop sensors. In an application programming interface communication mode, 3 XBee series 1 modules send and receive data in a wireless manner. The prototype of the system was tested with promising results in the case of the patients with inattention disorder. This system can be used for monitoring the activities of a patient and also for actuating certain stimulus in the patient side in case of necessity

Electron Micro­scopic Studies on Retinochoroidal Atrophy in the Human Eye

Nine eyeballs were enucleated from nine patients with excessive myopia, secondary retinochoroidal atrophy, absolute glaucoma, uveal malignant melanoma, Behcet's disease and sympathetic ophthalmia. The retina and choroid were studied with light and electron microscopes. The results were: In excessive myopia, marked blockade of choriocapillaries was accompanied by progressive retinal degeneration. In secondary retinochoroidal atrophy induced by retrobulbar fibrosis, the choriocapillaries were partially blocked and the retina had markedly degenerated. In Behcet's disease, exudative inflammation was recognized in the choroid extending to the retina and causing retinal detachment, though the choriocapillaries remained morphologically normal. In sympathetic ophthalmia, both the choriocapillaries and the retina remained normal, though marked inflammation was recognized in the outer layer of the choroid. In absolute glaucoma, the fine structures of the choriocapillary were well preserved in spite of bulbar hypertonia. In uveal malignant melanoma, the ultra structure of the choriocapillary near the tumor was well preserved. The choriocapillaries were normal even when the retina had degenerated. Retinal degeneration was recognized when changes such as blockage, disappearance, dilatation and increased permeability were found in the choriocapillaries. Damage to the choriocapillaries might play an important role in inducing and developing retinochoroidal atrophy.</p

Enhancement of DNA synthesis of mouse myelogenous cells by cyclic adenosine 3',5'-monophosphate (cAMP)

To observe the possible role of cAMP on the DNA synthesis during specialization-division of myelogenous precursor cells, the authors observed the DNA and RNA synthesis of the cells by in vitro autoradiography. And it is concluded that cAMP or its dibutyryl derivative added to the media penetrated into myelogenous precursor cells and metamyelocytes of mice and enhanced the DNA synthetic capacity of them. cAMP hardly enhanced RNA synthesis. Discussion is made on relation between enhancement of DNA synthesis of metamyelocytes and their possible rejuvenation.</p

Chronic Subdural Hematoma Associated with External Decompression for Acute Traumatic Intracranial Hematoma: report of two cases

A report is presented on two cases of chronic subdural hematoma which occurred after craniotomy, removal of the hematoma and external decompression for traumatic intracranial hematoma. As for the pathogenesis of chronic subdural hematoma of these two cases, these chronic subdural hematomas were considered to have originated from the subdural collection of mixed fluid of cerebrospinal fluid and blood caused by tearing of the arachnoid on head injury or craniotomy in the space between the brain and dural plasty. Opening and irrigating the hematoma cavity proved adequate as treatment at cranioplasty

The role of glucocorticoid receptors in the induction and prevention of hippocampal abnormalities in an animal model of posttraumatic stress disorder

Rationale: Since the precise mechanisms of posttraumatic stress disorder (PTSD) remain unknown, effective treatment interventions have not yet been established. Numerous clinical studies have led to the hypothesis that elevated glucocorticoid levels in response to extreme stress might trigger a pathophysiological cascade which consequently leads to functional and morphological changes in the hippocampus. Objectives: To elucidate the pathophysiology of PTSD, we examined the alteration of hippocampal gene expression through the glucocorticoid receptor (GR) in the single prolonged stress (SPS) paradigm, a rat model of PTSD. Methods: We measured nuclear GRs by western blot, and the binding of GR to the promoter of Bcl-2 and Bax genes by chromatin immunoprecipitation-qPCR as well as the expression of these 2 genes by RT-PCR in the hippocampus of SPS rats. In addition, we examined the preventive effects of a GR antagonist on SPS-induced molecular, morphological, and behavioral alterations (hippocampal gene expression of Bcl-2 and Bax, hippocampal apoptosis using TUNEL staining, impaired fear memory extinction (FME) using the contextual fear conditioning paradigm). Results: Exposure to SPS increased nuclear GR expression and GR binding to Bcl-2 gene, and decreased Bcl-2 mRNA expression. Administration of GR antagonist immediately after SPS prevented activation of the glucocorticoid cascade, hippocampal apoptosis, and impairment FME in SPS rats. Conclusion: The activation of GRs in response to severe stress may trigger the pathophysiological cascade leading to impaired FME and hippocampal apoptosis. In contrast, administration of GR antagonist could be useful for preventing the development of PTSD.This work was supported by the Japan Society for the Promotion of Science (JSPS) KAKENHI (a grant-in aid for Scientific Research, C) Grant Number JP18K07562, and Takeda Science Foundation

Preparation of a CuGaSe2 single crystal and its photocathodic properties

Chalcopyrite CuGaSe2 single crystals were successfully synthesized by the flux method using a home-made Bridgman-type furnace. The grown crystals were nearly stoichiometric with a Se-poor composition. Although a wafer form of the thus-obtained single crystal showed poor p-type electrical properties due to such unfavorable off-stoichiometry, these properties were found to be improved by applying a post-annealing treatment under Se vapor conditions. As a result, an electrode derived from the Se-treated single crystalline wafer showed appreciable p-type photocurrents. After deposition of a CdS ultrathin layer and a nanoparticulate Pt catalyst on the surface of the electrode, appreciable photoelectrochemical H2 evolution was observed over the modified electrode under photoirradiation by simulated sunlight with application of a bias potential of 0 VRHE

IL-7 promotes long-term in vitro survival of unique long-lived memory subset generated from mucosal effector memory CD4(+) T cells in chronic colitis mice

Colitogenic memory CD4(+) T cells are important in the pathogenesis of inflammatory bowel disease (IBD). Although memory stem cells with high survival and self-renewal capacity were recently identified in both mice and humans, it is unclear whether a similar subset is present in chronic colitis mice. We sought to identify and purify a long-lived subset of colitogenic memory CD4(+) T cells, which may be targets for treatment of IBD. A long-lived subset of colitogenic memory CD4(+) T cells was purified using a long-term culture system. The characteristics of these cells were assessed. Interleukin (IL)-7 promoted the in vitro survival for >8 weeks of lamina propria (LP) CD4(+) T cells from colitic SOD mice previously injected with CD4(+)CD45RB(high) T cells. These cells were in a quiescent state and divided a maximum of 5 times in 4 weeks. LP CD4(+) T cells expressed higher levels of Bcl-2, integrin-alpha 4 beta 7, CXCR3 and CD25 after than before culture, as well as secreting high concentrations of IL-2 and low concentrations of IFN-gamma and IL-17 in response to intestinal bacterial antigens. LP CD4(+) T cells from colitic mice cultured with IL-7 for 8 weeks induced more severe colitis than LP CD4(+) T cells cultured for 4 weeks. We developed a novel culture system to purify a long-lived, highly pathogenic memory subset from activated LP CD4(+) T cells. IL-7 promoted long-term in vitro survival of this subset in a quiescent state. This subset will be a novel, effective target for the treatment of IBD

Structure of the inhibitor complex of old yellow enzyme from Trypanosoma cruzi

The structures of old yellow enzyme from Trypanosoma cruzi which produces prostaglandin F2α from PGH2 have been determined in the presence or absence of menadione