picibanil and Cerebral-Infarction

Fetal exposure to inflammatory mediators is associated with a greater risk of brain injury and may cause endothelial dysfunction; however, nearly all the evidence is derived from gram-negative bacteria. Intrapleural injections of OK-432, a killed Su-strain of Streptococcus pyogenes, has been used to treat fetal chylothorax. In this study, we evaluated the neural and cardiovascular effects of OK-432 in preterm fetal sheep (104 +/- 1 days, term 147 days). OK-432 (0.1 mg, n = 6) or saline vehicle (n = 7) was infused in the fetal pleura, and fetuses were monitored for 7 days. Blood samples were taken routinely for plasma nitrite measurement. Fetal brains were taken for histological assessment at the end of the experiment. Between 3 and 7 h postinjection, OK-432 administration was associated with transient suppression of fetal body and breathing movements and electtroencephalogram activity (P < 0.05), increased carotid and femoral vascular resistance (P < 0.05), but no change in blood pressure. Brain activity and behavior then returned to normal except in one fetus that developed seizures. OK-432 fetuses showed progressive, sustained vasodilatation (P < 0.05), with lower blood pressure after 4 days (P < 0.05), but normal heart rate. There were no changes in plasma nitrite levels. Histological studies showed bilateral infarction in the dorsal limb of the hippocampus of the fetus that developed seizures, but no injury in other fetuses. We conclude that a single low-dose injection of OK-432 can be associated with risk of focal cerebral injury in the preterm fetus and chronic central and peripheral vasodilatation that does not appear to be mediated by nitric oxide.

Topics: Animals; Blood Pressure; Brain; Cardiovascular System; Cerebral Infarction; Electroencephalography; Female; Fetal Blood; Fetal Movement; Gestational Age; Heart Rate; Hemodynamics; Infusions, Parenteral; Nitrites; Picibanil; Pleura; Pregnancy; Respiratory Mechanics; Seizures; Sheep; Time Factors; Vascular Resistance; Vasodilation

We report a case of cerebral arterial air embolism that was followed by a brain computed tomographic scan and magnetic resonance imaging during the first week after onset. A 73-year-old man was admitted for treatment of pleural dissemination that was a recurrence after right lower bilectomy for advanced lung cancer. Thirty minutes after an anti-drug administration through the chest drainage tube, he lost consciousness shortly after coughing. A bubble in the inferior sagittal sinus was observed on the day of the stroke, which then disappeared within 24 hours. It seems that the anti-cancer agent evoked inflammation at the visceral pleura and the subject inhaled massive air flow into the systemic circulation.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Brain Edema; Brain Ischemia; Bronchial Fistula; Carcinoma, Squamous Cell; Cerebral Infarction; Chest Tubes; Cisplatin; Coma; Combined Modality Therapy; Cough; Disease Progression; Embolism, Air; Fatal Outcome; Fistula; Hemiplegia; Humans; Injections; Intracranial Embolism; Lung Neoplasms; Lymph Node Excision; Male; Picibanil; Pleura; Pleural Cavity; Pleural Effusion, Malignant; Pneumonectomy; Postoperative Complications; Pulmonary Veins