Postoperative transient tetraplegia in two patients caused by cervical spondylotic myelopathy.

We report two patients with cervical spondylotic myelopathy following non-cervical spine surgery. These cases revealed postoperative transient tetraplegia with respiratory insufficiency despite optimal anaesthetic management. Both patients showed no limitation of their neck movement at pre-operative airway examination. In addition, their necks had never been overextended during anaesthesia including tracheal intubation. However, postoperative magnetic resonance imaging showed cervical spondylotic myelopathy. Cervical disc herniation and protrusion of a hypertrophic ligamentum flavum caused spinal canal cord compression, and, these may lead to tetraplegia and phrenic nerve impairment. Their muscle weakness gradually improved and completely recovered the following morning. We should consider the existence of cervical spondylosis in the elderly patients over the age of 60 years.

Exercise training and energy restriction decrease neutrophil phagocytic activity in judoists.

PURPOSE: To investigate the effects of weight reduction as the result of exercise training and energy restriction on neutrophil function. METHODS: Eighteen male competitive college judoists participated in the study. In a whole blood assay, oxidative burst activity, phagocytic activity, expressions of Fc gamma receptor 3 (CD16), and complement receptor 3 (CD11b) of neutrophils were measured on a per cell basis by flow cytometry at day 20, 5, and 1 before and at day 7 after the competition. RESULTS: The rate of neutrophil producing reactive oxygen species decreased before the competition, whereas the oxidative burst activity per cell increased significantly in all subjects, which resulted in a significant increase of the total oxidative burst activity. However, there were no significant effect of energy restriction on oxidative burst activity. The rate of neutrophils incorporating opsonized zymosan decreased significantly with energy restriction. The total phagocytic activity of 10,000 neutrophils and the phagocytic activity per cell also decreased significantly by severe energy restriction. The surface antigen expressions of CD11b and CD16 were unaffected by weight reduction. CONCLUSIONS: The results suggest that with respect to the management of health conditions, weight reduction for judoists should be composed of exercise training and energy restriction should be moderate.

Effect of decaglycerol monooleate on phagocytosis and respiratory burst activity of human neutrophils: an in vitro study.

Decaglycerol monooleate (DGMO), a type of polyglycerol esters of fatty acids (PGEF), was evaluated for its in vitro effect on phagocytosis and respiratory burst activity of isolated human neutrophils using flow cytometric assay. Opsonized zymosan particles labelled with FITC (FITC-OZ) were employed as an indicator of phagocytosis. Fluorescence of FITC-OZ attached on to the surface of neutrophils was quenched by addition of trypan blue solution. After 10 minutes of incubation with DGMO up to a concentration of 10 mg/ml, neutrophil phagocytosis was not affected markedly. At the same time, the DGMO emulsion left little influence on complement receptor type three (CR3) that is associated with phagocytosis. On the other hand, oxidation of hydroethidine, which was used as an indicator of intracellular generation of reactive oxygen species (mainly for superoxide anion), was significantly inhibited by DGMO over 1 mg/ml. However, this phenomenon was not seen in DGMO-treated neutrophils when DGMO was removed after incubation. The present data suggest that DGMO does not affect phagocytosis of human neutrophils but down-regulates respiratory burst activity.

Circulating cytokines and hormones with immunosuppressive but neutrophil-priming potentials rise after endurance exercise in humans.

To investigate the mechanisms of exercise-induced immune perturbations, we measured promising immunomodulatory hormones and cytokines in plasma of 16 male marathon runners before and after a competitive 42.195-km race. Interleukin 1-beta (IL-1beta) and interferon gamma (IFN-gamma) concentrations remained unchanged after the marathon. The cytokines IL-12, IFN-alpha and tumour necrosis factor alpha (TNF-alpha) could not be detected even using highly sensitive specific immunoassays, indicating at least that overshooting responses of these cytokines had not occurred after exercise. As mechanisms for the small changes in these cytokines, we demonstrated for the first time a significant rise in concentrations of inhibitory cytokine IL-10 in addition to the immunosuppressive hormone cortisol, although concentrations of IL-4 and transforming growth factor-beta (TGF-beta) were unaffected by the race. Furthermore, concentrations of IL-1 receptor antagonist (IL-1ra) and IL-6, which are negative-feedback inhibitors of cytokine production, increased by more than 100 times. As for humoral mediators of neutrophil mobilization, concentrations of growth hormone (GH), cortisol and granulocyte colony-stimulating factor (G-CSF) increased significantly. In addition, concentrations of neutrophil-priming substances (IL-6, IL-8, G-CSF, GH and prolactin) also increased significantly and the induction of IL-8 and G-CSF with exercise was demonstrated for the first time in the present study. In contrast, IL-2 concentration decreased, by 32%, and this was correlated with the induction of nitric oxide (NO) production. Muscle damage, monitored using changes in concentrations of creatine kinase and myoglobin, was also observed. These results suggested that exercise-induced pathogenesis including previously reported immunosuppression and neutrophil hyper-reactivity might be attributed, at least partly, to the systemic dynamics of the above bioactive substances.

Applicability of chemiluminescence to assess the degree of operative stress in patients undergoing spinal surgery.

This study examined the applicability of luminol-dependent chemiluminescence (CL) response of neutrophils to assess the degree of stress of spinal surgery by measuring the capacity of circulating neutrophils to produce reactive oxygen species and the levels of serum cytokines: interleukin(IL)-1beta, IL-6, IL-8, tumour necrosis factor (TNF)-alpha and granulocyte colony stimulating factor (G-CSF). Ten male patients underwent spinal surgery. Peripheral blood samples, collected before and after the operation and the next morning, were used for measuring the CL response of neutrophils stimulated with opsonized zymosan and measuring the levels of serum cytokines. The operative stress induced leukocytosis, particularly granulocytosis, and increased serum IL-6 and G-CSF significantly. However, there was no significant change in the luminol-dependent CL response of neutrophils or the levels of serum IL-1beta, IL-8 and TNF-alpha throughout the experimental period. These results suggest that, at least in the early postoperative period, operative stress does not prime the circulating neutrophils, and thus the CL response of neutrophils is not appropriate to assess the degree of stress of spinal surgery.

Effect of decaglycerol mono-oleate on chemiluminescence of human neutrophils.

Decaglycerol mono-oleate (DGMO), a type of food additive (a polyglycerol ester of fatty acids), was evaluated for its in vitro effect on reactive oxygen species (ROS) generation by human neutrophils using a luminol-dependent chemiluminescence assay. Neutrophils were isolated by the Histopaque-1077/1119 double density gradient technique. Opsonized zymosan (OZ) and phorbol 12-myristate 13-acetate (PMA) were employed as artificial stimuli. DGMO inhibited the chemiluminescence response of OZ-stimulated neutrophils by 58% (p < 0.01) at a concentration of 0.5 mg/mL. DGMO inhibited the PMA-induced chemiluminescence by 40% (p < 0.01) at a concentration of 0.01 mg/mL. The inhibition phenomena could not be attributed to light absorption by DGMO alone, because the percentage chemiluminescence in the presence of DGMO is lower than the percentage transmittance of DGMO at 425 nm. These results suggest that DGMO downregulates ROS generation by human neutrophils.