The removal of excess glutamate from brain fluids after acute insults such as closed head injury (CHI) and stroke is expected to prevent excitotoxicity and the ensuing long lasting neurological deficits. Since blood glutamate scavenging accelerates the removal of excess glutamate from brain into blood and causes neuroprotection, we have evaluated here whether the neuroprotective properties of pyruvate could be partly accounted to its blood glutamate scavenging activity. The neurological outcome of rats after CHI improved significantly when treated with intravenous pyruvate (0.9 mmoles/100 g) but not with pyruvate administered together with glutamate. Pyruvate, at 5 micromole/100 g rat was neither protective not able to decrease blood glutamate but displayed the latter two properties when combined with 60 microg/100 g of glutamate-pyruvate transaminase. Since the neurological recovery from CHI was correlated with the decrease of blood glutamate levels, we conclude that pyruvate blood glutamate scavenging activity contributes to the spectrum of its neuroprotective mechanisms.

Cellulitis, a diffuse inflammation of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin, is a common lesion in children, usually responsive to systemic antibiotic therapy. However, an unusual course of healing or some nontypical features should call the treating physician to consider and investigate for other diagnoses that might prevent unnecessary treatment and alleviate parental stress. We present a case of posttraumatic fat necrosis, demonstrating some pitfalls in the process of diagnosis.

Initial clinical trials and surveillance data have shown that the most commonly administered BNT162b2 COVID-19 mRNA vaccine is effective and safe. However, several cases of mRNA vaccine-induced mild to moderate adverse events were recently reported. Here, we report a rare case of myositis after injection of the first dose of BNT162b2 COVID-19 mRNA vaccine into the left deltoid muscle of a 34-year-old, previously healthy woman who presented progressive proximal muscle weakness, progressive dysphagia, and dyspnea with respiratory failure. One month after vaccination, BNT162b2 vaccine mRNA expression was detected in a tissue biopsy of the right deltoid and quadriceps muscles. We propose this case as a rare example of COVID-19 mRNA vaccine-induced myositis. This study comprehensively characterizes the clinical and molecular features of BNT162b2 mRNA vaccine-associated myositis in which the patient was severely affected.

No abstract

No abstract

Urinothorax or urothorax, the presence of urine in the pleural space, is a rare complication of percutaneous access to the kidney for the management of complex renal and proximal ureteral calculi and ureteropelvic junction obstruction. Other causes such as blunt renal trauma, ureteral instrumentation, or ureteral surgery have also been reported. The authors describe a patient with a massive left pleural effusion with total lung atelectasis. The diagnosis of urinothorax was confirmed by diuretic renography with Tc-99m diethylenetriamine pentaacetic acid.

Vertebral body erosion is a rare late complication of tracheostomy. Here we present the case of a 30-yearold female patient, in a vegetative state after severe brain injury, with a permanent tracheostomy and prolonged mechanical ventilation, who suffered from recurrent episodes of severe air leakage with oxygenation drop due to a puncture in the tracheostomy tube cuff. A neck computed tomography (CT) detected destruction of two vertebral bodies, C7 and Th1, and a bony fragment -a remnant of C7 penetrated the trachea and probably repetitively punctured the inflated cuff. A biopsy of the C7 vertebral body was performed under CT guidance to rule out osteomyelitis. The biopsy revealed necrotic bone spicules surrounded by vascular-rich fibrous tissue, without evidence of inflammation. C7 vertebral body avascular osteonecrosis was diagnosed. The case highlights the importance of monitoring cuff pressure during longterm use of cuffed endotracheal tubes to avoid hyperinflation and subsequent ischemic complications.

No abstract