Nontraumatic postmortem computed tomographic demonstration of cerebral gas embolism following cardiopulmonary resuscitation.

PURPOSE: The aim of this study was to investigate cerebral gas embolism (GE) on nontraumatic postmortem CT (PMCT), regarding its frequency, location (arterial or venous), and causes. MATERIALS AND METHODS: Our subjects were 404 nontraumatically deceased patients who had been in a state of cardiopulmonary arrest on arrival at our emergency room. PMCT was performed within 2 h of the confirmation of death. RESULTS: Cardiopulmonary resuscitation (CPR) was performed on 387 of the 404 subjects; and of these, cerebral GE was detected in 29 (7.5%) subjects (3 arterial, 25 venous, 1 undeterminable). Cerebral GE was not noted in the other 17 of the 404 subjects who did not undergo CPR. However, there was no significant difference in the incidence of cerebral GE between the subjects who underwent CPR and those who did not. The mechanism of cerebral arterial GE was presumed due to pulmonary barotrauma and/or paradoxical embolism, while the thoracic pump theory was suggested to explain the cerebral venous GE. CONCLUSION: Cerebral arterial/venous GE is found in CPR cases on nontraumatic PMCT.

Effect of propranolol on hyphae formation signal in Candida albicans.

Candida albicans (C. albicans) is known as an opportunistic pathogen that changes from a yeast form to a hyphae form in response to various outside environmental signals. The addition of propranolol inhibited hyphae formation of C. albicans. Propranolol inhibited the expression of agglutinin like sequence 3 (ALS3) and ALS8mRNA, which are regulated by the cAMP-EFG1 pathway in C. albicans. Propranolol did not affect the expression of CST20, HST7 or CPH1mRNA, which are components of the mitogen-activated protein (MAP) kinase cascade in C. albicans. The expression of CYR1mRNA, which encodes adenylate cyclase of C. albicans, was not affected by propranolol. These findings indicated that the interruption of hyphae formation by propranolol is caused by inhibition of the cAMP-EFG1 pathway, but not effects on the MAP kinase cascade.

Postmortem computed tomography findings as evidence of traffic accident-related fatal injury.

PURPOSE: Most traumatic deaths in Japan are due to nonpenetrating injuries, especially those that result from traffic accidents; however, the autopsy rate of traffic accident-related deaths is only about 5%. We investigated the diagnostic ability of postmortem computed tomography (PMCT) in cases of fatal trauma after traffic accidents. MATERIALS AND METHODS: Our subjects were 78 subjects (59 males, 19 females; mean age 50 years, range 15-87 years) who were brought to our institution in cardiopulmonary arrest on arrival after traffic accidents and died despite resuscitation attempts. PMCT findings of damage to the head, neck, thorax, abdomen, and pelvis were classified into three grades according to the Abbreviated Injury Scale (AIS) severity: A: 1 (minor), 2 (moderate); B: 3 (serious), 4 (severe), 5 (critical); C: 6 (maximum). RESULTS: The percentage ratio of A/B/C in 78 head injuries was 32/60/8, in 41 neck injuries 83/5/12, in 76 thorax injuries 5/38/57, in 76 abdominal injuries 70/24/7, and in 76 pelvic injuries 79/21/0, respectively. CONCLUSION: PMCT can detect or presume fatal trauma when diagnosing the cause of death after traffic accidents.

[Growth-inhibitory activity of Cladosporium cladosporioides by cysteine].

When Cladosporium cladosporioides was cultured with cysteine, its growth was completely inhibited statically. The growth of C. cladosporioides cultured on potato-dextrose agar plates was also inhibited by the addition of cysteine. The production of ATP in C. cladosporioides was inhibited by cysteine. When a silicone block was incubated with C. cladosporioides, the surface of the block was coated with the biofilm of C. cladosporioides. However, the block containing cysteine was not covered with biofilm. These results indicate that cysteine is useful as a material to prevent the growth of C. cladosporioides.

Effect of direct hemoperfusion with a polymyxin B immobilized fiber column on high mobility group box-1 (HMGB-1) in severe septic shock: report of a case.

Because of the many difficult aspects in the treatment of septic shock and poor outcome of this condition, establishing the most appropriate therapeutic strategy is problematic. Recently, high mobility group box-1 (HMGB-1) has been shown to activate inflammatory responses and to be a late mediator in endotoxemia and sepsis. Therefore, we considered that it might be worthwhile to investigate the therapeutic potential of HMGB-1 blockade in cases of septic shock.Herein, we describe the case of a patient with septic shock with hepatic portal venous gas caused by intestinal obstruction. Hepatic portal venous gas is a rare condition associated with significant radiographic findings and a fatal outcome. Our patient, however, recovered from severe septic shock and was saved by the use of direct hemoperfusion with a polymyxin B immobilized fiber column (DHP-PMX). This treatment resulted in a decrease in the serum levels of endotoxin, interleukin-6 (IL-6), and HMGB-1.

Effectiveness of a "doctor-helicopter" system in Japan.

BACKGROUND: In Japan, helicopters have rarely been used for emergency medical services. The use of helicopters not only ensures rapid evacuation but may also serve to provide emergency management to patients with life-threatening injuries in the prehospital setting. OBJECTIVES: To evaluate a Japanese helicopter-based emergency medical system including an onboard physician, particularly in terms of probability of survival. METHODS: We conducted a retrospective review of trauma victims, and calculated two estimates of PS--at the scene and on arrival at the emergency department--based on patient age, Injury Severity Score, and Revised Trauma Score. RESULTS: We identified trauma victims who had an ISS above 15 and were transported from the scene by helicopter. Excluding cardiopulmonary arrest at the scene, 151 cases were studied. Thirty-two patients had hemodynamic instability with systolic blood pressures below 90 mmHg, caused by hemorrhagic shock (29 cases) or obstructive shock (3 cases). Their PS values were 0.56 +/- 0.38 in the prehospital setting and 0.65 +/- 0.38 on arrival at the ED, representing a significant difference (P = 0.0003). Twenty-four of these patients survived, reflecting successful resuscitation during prehospital and ED management. CONCLUSIONS: A doctor-helicopter system was shown to improve probability of survival for life-threatening trauma in the Japanese emergency medical system.

[Effect of glucose on luciferase expression in Photobacterium leiognathi].

Photobacterium leiognathi cultured in marine broth emits a luminescence that is temporarily enhanced and then extinguished by glucose. Glucose reduces the luciferase level and the expression of lux ABG mRNA in P. leiognathi. The amount of ATP in P. leiognathi is temporarily increased and then declines to the normal level. These results indicate that the extinguishing by glucose in P. leiognathi is induced by the interruption of the translation of luciferase.

Role of Ca2+/calmodulin signaling pathway on morphological development of Candida albicans.

A human fungal pathogen, Candida albicans, varies from the yeast form to the hyphal form due to various external signals. This morphogenetic transformation has been implicated in the development of pathogenicity. In this report, we show that calmodulin inhibitors (TFP and W-7) and an adenylatecyclase inhibitor (MDL-12-330A) suppressed the hyphae formation of C. albicans. Furthermore, the expression of hyphae-specific mRNAs located downstream from the RAS1-cAMP pathway was inhibited by these inhibitors. Suppression of hyphae formation by TFP or W-7 was not inhibited by the addition of cAMP, and these inhibitors did not affect the amount of cAMP in C. albicans. These results suggest that the Ca2+/calmodulin pathway contributes to hyphae formation and is related to the RAS1-cAMP pathway.

Hyphae formation of Candida albicans is regulated by polyamines.

Candida albicans generally grows in hyphae form in RPMI1640 medium. However, addition of 1,4-diamino-2-butanone (DAB), a competitive inhibitor of ornithine decarboxylase, decreased the amount of polyamines in C. albicans, and induced the proliferation of the C. albicans yeast form. The expression of CYR1 mRNA was significantly inhibited by the addition of DAB compared with that of the control. The amount of intracellular cAMP was also decreased by the addition of DAB. A specific adenylate cyclase inhibitor, cis-N-[2-phenylcyclopentyl]-azacyclotridec-1-en-2-amine (MDL-12,330A) promoted the growth of the yeast form. These results indicated that polyamines exist upstream of the adenylate cyclase-cAMP signal pathway and regulate the transformation of C. albicans.

Peripartum cardiomyopathy and biventricular thrombi.

Peripartum cardiomyopathy is a rare cardiac disorder characterized by the development of heart failure in the last month of pregnancy or up to 5 months postpartum in women without other determinable causes of cardiac failure. Intracardiac thrombi have been found at autopsy in some patients with this condition and have been demonstrated in the left or right ventricles on 2-dimensional echocardiography. A 23-year-old woman presented with peripartum cardiomyopathy and biventricular thrombi on echocardiography. The thrombi were spherical, pedunculate, shaggy and irregular in configuration, and freely mobile, suggesting that they were fresh. She was treated with conventional heart failure therapy and anticoagulants. Four days later, the apical thrombi within both ventricles had disappeared and there was no evidence of embolism on physical examination. The hypercoagulable state of the peripartum period and the severe biventricular dysfunction most likely led to the formation of biventricular thrombi.