Background and Purpose: Very few reports are available on changes in the human hippocampus after cardiac arrest. The objective of this study was to investigate if specific hippocampal volume losses can be demonstrated in the human brain following reperfusion after cardiac arrest. Methods: We assessed the volumes of the hippocampal formation (HF) and temporal lobe excluding HF (TL) as the contrast using magnetic resonance (MR)-imaging-based volumetry in 11 vegetative patients after cardiac arrest and in 22 healthy controls of similar age, sex and body size distribution. The measured volumes were normalized for differences in the head size among subjects by dividing by the total intracranial volume (TICV). The MR images of the 11 patients were obtained between days 8 and 21 after cardiac arrest. Results: The observed volumes of HFs and TLs of both patient and control groups were as follows: right HF volume (HFV): 2.67 ± 0.19 (mean ± SD, cm3) in patients versus 3.89 ± 0.44 in controls; left HFV: 2.72 ± 0.17 versus 3.74 ± 0.35; right TL volume (TLV): 73.37 ± 6.54 versus 80.08 ± 7.62, and left TLV: 72.45 ± 6.77 versus 78.59 ± 6.68. The normalized indices (HFV/TICV and TLV/TICV) were as follows: right HF: 0.0021 ± 0.0002 (mean ± SD) in patients versus 0.0031 ± 0.0001 in controls, p < 0.0001, left HF: 0.0022 ± 0.0002 versus 0.0030 ± 0.0001, p < 0.0001, right TL: 0.058 ± 0.002 versus 0.064 ± 0.004, p = 0.0007, and left TL: 0.058 ± 0.002 versus 0.062 ± 0.004, p = 0.0014. The HFV-TLV ratios (HFV/TICV divided by TLV/TICV) of both groups were: right HFV-TLV ratio: 0.037 ± 0.004 in patients versus 0.049 ± 0.004 in controls, p < 0.0001, left HFV-TLV ratio: 0.038 ± 0.004 versus 0.048 ± 0.004, p < 0.0001. Conclusions: The patient group had HFs that were 26.8–30.6% smaller than those of the control group, but in the patient group, the TLs slightly decreased in size by only 7.8–8.2% of the volume of those in the control group within 21 days after cardiac arrest. The volume reductions in the bilateral HFs of patients after cardiac arrest were significantly larger than those in the bilateral TLs. We speculate that this specific rapid hippocampal shrinkage reflects its greater vulnerability to global brain ischemia.
Adrenomedullin (AM), a novel vasodilatory peptide, appears to participate in the regulation of circulation. Recent studies have reported a relationship between AM and cytokine. The present study was performed to determine whether major surgery, which is accompanied by an altered cytokine production, affects the concentration of plasma AM. Eighteen patients undergoing major upper abdominal and thoracoabdominal surgery were thus studied. Arterial blood samples were obtained before anesthetic induction (PRE), 2h after a surgical incision was made (2H), at the end of surgery (END), at postoperative day 1 (1POD), and at 3POD. The concentrations of plasma AM and serum interleukin (IL)-6 were measured. The levels of plasma AM were found to be significantly higher at END (P < 0.001), 1POD (P < 0.0001), and 3POD (P < 0.05) compared with PRE. A significant correlation was found between the concentrations of serum IL-6 and plasma AM (r = 0.59, n = 18, P < 0.01). These results suggest that major surgical stress might thus increase the plasma AM concentration, and such an increase may be related to cytokine induction.
The authors present a rare case of tetraplegia after coronary artery bypass grafting. It is suggested that neck extension during surgery might have aggravated an occult preexisting cervical spinal canal stenosis to produce cervical injury.
A 72-year-old woman with a history of early breast cancer suffered a fracture of the eighth thoracic vertebra resulting in paraplegia. Magnetic resonance imaging (MRI) showed spinal cord compression by a tumor between the ninth and tenth thoracic vertebrae. Local radiotherapy was begun under the diagnosis of metastatic breast cancer, but bone marrow aspiration and biopsy subsequently revealed plasma-cell proliferation rather than adenocarcinoma. This case report serves to demonstrate that clinicians should consider multiple myeloma as a cause of lytic bone lesions without extraskeletal metastases even in patients with a history of breast cancer.
A 72-year-old woman with a history of early breast cancer suffered a fracture of the eighth thoracic vertebra resulting in paraplegia. Magnetic resonance imaging (MRI) showed spinal cord compression by a tumor between the ninth and tenth thoracic vertebrae. Local radiotherapy was begun under the diagnosis of metastatic breast cancer, but bone marrow aspiration and biopsy subsequently revealed plasma-cell proliferation rather than adenocarcinoma. This case report serves to demonstrate that clinicians should consider multiple myeloma as a cause of lytic bone lesions without extraskeletal metastases even in patients with a history of breast cancer.
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