Upregulation of chemokine expression in murine cornea due to mechanical trauma or endotoxin.

BACKGROUND AND AIMS: Allograft rejection is the commonest cause of corneal transplant failure and is significantly higher in high-risk patients. Corneal tissue is reported to produce chemokines in response to stress/inflammation. Expression of chemokines is central to the recruitment of leucocytes during inflammatory events. This study was designed to evaluate the effects of surgical trauma or storage conditions on chemokine expression. METHODS: Murine corneas were manipulated by incubation in different conditions for up to 24 h, by the addition of endotoxin or by surgical trauma. The ex vivo production of chemokines was assessed using a real-time reverse-transcriptase PCR (RT-PCR) assay to measure mRNA encoding MIP-1alpha, MIP-1beta and MIP-1gamma, MCP1, IP-10, lymphotactin, fractalkine, RANTES, eotaxin, MIG, MIP2 and the cytokine MIF. The expression of RANTES was also determined by ELISA, and the ability of supernatant from corneas on chemotaxis of cells was also determined. Finally, we compared the survival of corneal grafts that had (or had not) been treated with endotoxin. RESULTS: We found that on incubation in corneal storage medium, expression of mRNA for the majority of these chemokines greatly increased. Upregulation of chemokine mRNA expression was also seen following the mechanical trauma of suture insertion and exposure of the cornea to endotoxin. In the case of mechanical trauma, functional activity of the chemokines was demonstrated using a chemotaxis assay. Orthotopic transplantation of LPS-treated corneas, in which chemokine expression was elevated, resulted in increased infiltration by leucocytes and more rapid rejection of allogeneic grafts. CONCLUSION: Our results indicate that ex vivo storage and manipulation of murine corneas can influence the expression of chemokines in corneas, and can result in earlier graft rejection. This may be of importance when considering procedures for manipulation and ex vivo storage of donor corneas prior to transplantation, as well as the surgical procedure itself.

High-pressure suction drainage via a polyurethane foam in the management of poststernotomy mediastinitis.

BACKGROUND: This study was performed to evaluate the effectiveness of suction drainage in the management of early poststernotomy mediastinitis. METHODS: From September 1998 to August 1999, we encountered nine cases of poststernotomy mediastinitis out of 1,209 adult median sternotomies performed in this time period. All these cases were treated with suction drainage, which was recently introduced to our management protocol. From September 1997 to August 1998, we encountered 11 cases of poststernotomy mediastinitis of 1,343 adult median sternotomies. All these cases were initially treated by closed drainage and irrigation, which was our previous first-line management. We used the latter group as historical controls for the evaluation of suction drainage. Lengths of hospitalization were compared using the Mann-Whitney U test, and success versus failure of the primary treatment was compared using the chi2 test. RESULTS: Treatment with the suction dressing resulted in a decreased length of hospitalization after treatment starts (p = 0.02) and a lower rate of treatment failure (p = 0.03). CONCLUSIONS: The use of high-pressure suction drainage is a valuable adjunct in the early management of poststernotomy mediastinitis.

Valve-sparing aortic root replacement.

Aortic root replacement with sparing of the aortic valve in selected patients with isolated sinus of Valsalva or sinotubular aneurysm and a normal valve provides the advantages of an anticoagulation-free milieu and a more physiological root hemodynamic. The clinical efficacy and durability have been documented. This report describes a simple and reproducible technique of aortic root remodeling that uses a prosthetic conduit as originally pioneered by Magdi Yacoub and later by Tirone David.

The core of the pseudostem of musa in the treatment of urinary stones.

Ayurveda recommends many simple herbs in the treatment of urological afflictions like urolithiasis. Seventyone patients diagnosed to be suffering from urolithiasis were treated with juice of the core of the pseudostem of Musa Paradisiaca and Musa sapientum. A significant segment of them passed out calculi of varying size after consuming the drug for two weeks. Recurrence of stone formation was also prevented by the treatment, The author concludes that the plant material is quite effective in curing urolithiasis, especially of the calcium oxalate variety.

Coronary arterial occlusion and myocardial infarction in acute myocarditis.

Coronary arterial occlusion may occur experimentally during acute myocarditis but has not been documented in man. We report the case of a young female with severe myocarditis who later required cardiac transplantation and in whom coronary occlusion was demonstrated arteriographically before transplantation and by pathological examination of the heart after explantation.