Tumor Necrosis Factor-Alpha in Plasma During Cardiopulmonary Bypass in a Pig Model Correlation With Marginated Neutrophils and Cerebral Edema by Magnetic Resonance Imaging

Objective Conventional cardiopulmonary bypass (CCPB) is a major trigger of inflammatory response. We aimed to assess the impact of two different minimized cardiopulmonary bypass systems (mini-CPB) with and without Bioline-coating compared with CCPB regarding organ function, inflammatory response, and early clinical outcome. Methods In a prospective, randomized study, 120 patients underwent elective coronary artery bypass grafting and were randomized into three groups: mini-CPB using a Bioline-coated (group A, n = 40) or an uncoated (group B, n = 40) circuit, or CCPB (group C, n = 40). Cytokines (interleukin-6, interleukin-8, and tumor necrosis factor-alpha), myocardial markers (creatine kinase [CK], CK-MB, and troponin-T), hematocrit, and platelet counts were measured up to 48 hours postoperatively. Early clinical outcome was assessed at 3 months postoperatively. Results Demographics, number of distal anastomoses, ventilation time, blood loss, intensive care unit, and hospital stay were comparable (P = not significant). Extracorporeal circulation and cross-clamp time were significantly longer in group A and B versus C (P < 0.005). No significant differences could be found in the release of interleukin-6, interleukin-8, and tumor necrosis factor-alpha among groups. Myocardial markers were significantly reduced in group A and B versus group C (P < 0.001). Hematocrit and platelet counts did not differ among the groups. No differences could be found in early clinical outcome up to 3 months. Conclusions This study showed significant better myocardial preservation with lower CK-MB and troponin-T levels in both mini-CPB groups. No significant differences could be found in terms of inflammation, hematologic effects, and early clinical outcome.

Download Full-text

Bilateral Paresthesias in Crohn Disease

10.1093/med/9780197583425.003.0070 ◽

2021 ◽

pp. 216-218

Author(s):

Amy C. Kunchok ◽

Andrew McKeon

Keyword(s):

Magnetic Resonance Imaging ◽

Cerebrospinal Fluid ◽

Cervical Spine ◽

Magnetic Resonance ◽

Tumor Necrosis Factor ◽

Contrast Enhancement ◽

Crohn Disease ◽

Tumor Necrosis ◽

Resonance Imaging ◽

Necrosis Factor

A 43-year-old woman sought care for bilateral lower limb numbness and paresthesias accompanied by a tight, bandlike sensation around her torso at the mid chest level. She had an episode 4 months earlier of bilateral arm paresthesias. The right arm paresthesias lasted several hours, but the left arm paresthesias persisted for 1 week. Urinary frequency had recently developed, but no incontinence. She had no associated limb weakness, facial numbness or weakness, or vision loss. Magnetic resonance imaging of the cervical spine showed multiple, short-segment, T2-hyperintense lesions. C1 and C4-5 lesions demonstrated contrast enhancement. Magnetic resonance imaging of the brain showed multiple ovoid areas of T2 hyperintensity involving the periventricular regions. Postcontrast images indicated 2 contrast-enhancing lesions adjacent to the posterior aspect of the right lateral ventricle. Magnetic resonance imaging of the thoracic spine showed several T2-hyperintense lesions without contrast enhancement. Vitamin B12 level was low. Cerebrospinal fluid analysis revealed 1 nucleated cell/µL, protein concentration of 85 mg/dL, and 17 cerebrospinal fluid -exclusive oligoclonal bands. Testing for JC polyoma virus was negative in the cerebrospinal fluid by polymerase chain reaction, but serologic results were positive. The patient was diagnosed with central nervous system demyelination in association with Crohn disease and tumor necrosis factor-α‎ inhibitor use. The patient discontinued adalimumab and started vedolizumab (α‎4β‎7 integrin inhibitor) for her Crohn disease. Magnetic resonance imaging of the brain and cervical spine 3 months after the therapy changes showed 2 new periventricular lesions in the temporal lobes without contrast enhancement. Magnetic resonance imaging of the cervical spine was stable. Because of her seropositivity to JC polyoma virus and history of immunosuppression, natalizumab (α‎4β‎1 and α‎4β‎7 integrin inhibitor) was not recommended. After discussion regarding therapy choice, the patient elected to start fingolimod. Inflammatory bowel and connective tissue diseases are commonly treated with immunosuppressants including tumor necrosis factor-α‎ inhibitors. Tumor necrosis factor-α‎ is a cytokine with a wide range of functions, including immune cell regulation, induction of the inflammatory response, inhibition of tumor growth, and induction of apoptosis.

Download Full-text