Traumatic abdominal wall hernia and Morel-Lavallee lesion in a pediatric patient.

Traumatic abdominal wall hernias and abdominal Morel-Lavallee lesions rarely occur in blunt abdominal trauma. There are only a few documented cases of these occurring simultaneously, especially in the pediatric population. We report a case of a 15-year-old boy with a concomitant traumatic abdominal wall hernia and Morel-Lavallee lesions. Abdominal wall reconstruction was performed successfully via the collaboration of trauma, minimally invasive surgery, and plastic surgery teams.

Exercise Training Attenuates Upregulation of p47(phox) and p67(phox) in Hearts of Diabetic Rats.

Exercise training (ExT) is currently being used as a nonpharmacological strategy to improve cardiac function in diabetic patients. However, the molecular mechanism(s) underlying its beneficial effects remains poorly understood. Oxidative stress is known to play a key role in the pathogenesis of diabetic cardiomyopathy and one of the enzyme systems that produce reactive oxygen species is NADH/NADPH oxidase. The goal of this study was to investigate the effect of streptozotocin- (STZ-) induced diabetes on expression of p47(phox) and p67(phox), key regulatory subunits of NADPH oxidase, in cardiac tissues and determine whether ExT can attenuate these changes. Four weeks after STZ treatment, expression of p47(phox) and p67(phox) increased 2.3-fold and 1.6-fold, respectively, in left ventricles of diabetic rats and these increases were attenuated with three weeks of ExT, initiated 1 week after onset of diabetes. In atrial tissues, there was increased expression of p47(phox) (74%), which was decreased by ExT in diabetic rats. Furthermore, increased collagen III levels in diabetic hearts (52%) were significantly reduced by ExT. Taken together, ExT attenuates the increased expression of p47(phox) and p67(phox) in the hearts of diabetic rats which could be an underlying mechanism for improving intracardiac matrix and thus cardiac function and prevent cardiac remodeling in diabetic cardiomyopathy.

Predictive factors for early postoperative hypocalcemia after surgery for primary hyperparathyroidism.

The purpose of this study was to identify patients at risk for hypocalcemia after parathyroid surgery. The charts of 99 patients who underwent parathyroid surgery over a 2-year period using a rapid intraoperative parathyroid hormone (IOPTH) assay were retrospectively reviewed. Data for patient demographics, preoperative parathyroid hormone and calcium levels, IOPTH levels, and postoperative calcium levels were reviewed, and trends were analyzed for patients who had postoperative hypocalcemia. Of the 99 patients, 91 had one gland excised and 8 had two glands excised. Preoperative calcium levels ranged from 8.9 to 15.6 mg/dL. Sixty-seven of the patients had a >50% drop in IOPTH at 5 minutes, and 82 had a >50% drop in IOPTH by 10 minutes. Twelve patients had early hypocalcemia. Parathyroid weight and surgery type were not significant factors in predicting postoperative hypocalcemia. A drop of >80% in IOPTH at 10 minutes was a significant factor for postoperative hypocalcemia (P = 0.02). In addition, having normal or only minimally elevated preoperative calcium was an independent risk factor for postoperative hypocalcemia (P = 0.05). Our study has shown that postoperative calcium supplementation and in-hospital monitoring should be considered in patients with a preoperative calcium level in the normal range and with an IOPTH that has dropped by >80%.

Interaction between glutamate and GABA systems in the integration of sympathetic outflow by the paraventricular nucleus of the hypothalamus.

The paraventricular nucleus (PVN) of the hypothalamus is a central site known to modulate sympathetic outflow. Excitatory and inhibitory neurotransmitters within the PVN dictate final outflow. The goal of the present study was to examine the role of the interaction between the excitatory neurotransmitter glutamate and the inhibitory neurotransmitter GABA in the regulation of sympathetic activity. In alpha-chloralose- and urethane-anesthetized rats, microinjection of glutamate and N-methyl-D-aspartate (NMDA; 50, 100, and 200 pmol) into the PVN produced dose-dependent increases in renal sympathetic nerve activity, blood pressure, and heart rate. These responses were blocked by the NMDA receptor antagonist DL-2-amino-5-phosphonovaleric acid (AP-5). Microinjection of bicuculline, a GABA(A) receptor antagonist, into the PVN (50, 100, and 200 pmol) also produced significant, dose-dependent increases in renal sympathetic nerve activity, blood pressure, and heart rate; AP-5 also blocked these responses. Using microdialysis and HPLC/electrochemical detection techniques, we observed that bicuculline infusion into the PVN increased glutamate release. Using an in vitro hypothalamic slice preparation, we found that bicuculline increased the frequency of glutamate-mediated excitatory postsynaptic currents in PVN-rostral ventrolateral medullary projecting neurons, supporting a GABA(A)-mediated tonic inhibition of this excitatory input into these neurons. Together, these data indicate that 1) glutamate, via NMDA receptors, excites the presympathetic neurons within the PVN and increases sympathetic outflow and 2) this glutamate excitatory input is tonically inhibited by a GABA(A)-mediated mechanism.