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PubMed1991

Evidence for entry of plasma insulin into cerebrospinal fluid through an intermediate compartment in dogs. Quantitative aspects and implications for transport.

To study the route by which plasma insulin enters cerebrospinal fluid (CSF), the kinetics of uptake from plasma into cisternal CSF of both insulin and [14C]inulin were analyzed during intravenous infusion in anesthetized dogs. Four different mathematical models were used: three based on a two-compartment system (transport directly across the blood-CSF barrier by nonsaturable, saturable, or a combination of both mechanisms) and a fourth based on three compartments (uptake via an intermediate compartment). The kinetics of CSF uptake of [14C]inulin infused according to an "impulse" protocol were accurately accounted for only by the nonsaturable two-compartment model (determination coefficient [R2] = 0.879 +/- 0.044; mean +/- SEM; n = 5), consistent with uptake via diffusion across the blood-CSF barrier. When the same infusion protocol and model were used to analyze the kinetics of insulin uptake, the data fit (R2 = 0.671 +/- 0.037; n = 10) was significantly worse than that obtained with [14C]inulin (P = 0.02). Addition of a saturable component of uptake to the two-compartment model improved this fit, but was clearly inadequate for a subset of insulin infusion studies. In contrast, the three-compartment model accurately accounted for CSF insulin uptake in each study, regardless of infusion protocol (impulse infusion R2 = 0.947 +/- 0.026; n = 10; P less than 0.0001 vs. each two-compartment model; sustained infusion R2 = 0.981 +/- 0.003; n = 5). Thus, a model in which insulin passes through an intermediate compartment en route from plasma to CSF, as a part of a specialized transport system for the delivery of insulin to the brain, best accounts for the dynamics of this uptake process. This intermediate compartment could reside within the blood-CSF barrier or it may represent brain interstitial fluid, if CNS insulin uptake occurs preferentially across the blood-brain barrier.

Animals↗

PubMed1995

groucho and hedgehog regulate engrailed expression in the anterior compartment of the Drosophila wing.

Drosophila imaginal discs are divided into units called compartments. Cells belonging to the same compartment are related by lineage and express a characteristic set of 'selector genes'. The borders between compartments act as organizing centres that influence cell growth within compartments. Thus, in the cells immediately anterior to the anterior-posterior compartment boundary the presence of the hedgehog product causes expression of decapentaplegic, which, in turn, influences the growth and patterning of the wing disc. The normal growth of the disc requires that posterior-specific genes, such as hedgehog and engrailed are not expressed in cells of the anterior compartment. Here we show that hedgehog can activate engrailed in the anterior compartment and that both hedgehog and engrailed are specifically repressed in anterior cells by the activity of the neurogenic gene groucho. In groucho mutant discs, hedgehog and engrailed are expressed at the dorsoventral boundary of the anterior compartment, leading to the ectopic activation of decapentaplegic and patched and to a localised increase in cell growth associated with pattern duplications. The presence of engrailed in the anterior compartment causes the transformation of anterior into posterior structures.

Animals↗

PubMed1990

Transcapillary forces in muscle compartments of lower limbs with deep venous thrombosis.

Interstitial fluid pressure (Pif), plasma- and interstitial fluid colloid osmotic pressures (COPpl, COPif) were measured in muscle compartments of the calf in lower limbs of patients with deep venous thrombosis (DVT) and in contralateral limbs. Pif was measured with the 'wick-in-needle' technique in the anterior and deep posterior compartments in three periods of time following start of treatment for DVT. The first period was from 0-24 h, the second from 24-48 h and the third later than 48 h. We found a significant increase in both muscular compartments in legs with DVT compared to the contralateral in the three periods except for Pif in the anterior compartment in the third period. A significant reduction of Pif in both muscular compartments of limbs with DVT was found when comparing the first and second periods but not from the second to the third period. No difference was found in Pif in the muscular compartments of the contralateral limbs between the three periods. Interstitial fluid for COPif measurements was obtained by inserting intravenous cannulas in the deep posterior muscle compartment of the calf of limbs with DVT and contralateral limbs. In oedematous tissue it was possible to collect some fluid, but this was almost impossible in the non-oedematous tissues of the contralateral limbs. COPif was 4.2(2.4) mmHg (mean(SD)) in the deep posterior compartment of limbs with DVT, which is probably significantly reduced. Increased Pif and reduced COPif indicate increased transcapillary fluid filtration and reduced reabsorption as the main cause of oedema in muscular compartments in DVT of the lower limbs.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed2003

A Bayesian 3-compartment model for 99mTc-MAG3 clearance.

UNLABELLED: Because recent reports have questioned the traditional 2-compartment model for calculating tracer clearance after a single intravenous injection, a 3-compartment model was evaluated in this study. METHODS: Bayesian statistics were used, which facilitated curve fitting by treating all subjects simultaneously. (99m)Tc-Mercaptoacetyltriglycine clearance data from 154 adults and 109 children were measured at several centers, typically 6-9 plasma samples spanning 5-90 min, and fitted by 2- and 3-compartment Bayesian models. RESULTS: Clearance estimates were found to be systematically lower for the 3-compartment model than for the 2-compartment model. A single-sample procedure based on the 3-compartment model was found to eliminate most of the known discrepancy between formulas based on single-injection and continuous-infusion reference methods. CONCLUSION: A 3-compartment model led to lower and probably more accurate clearance estimates than the conventional 2-compartment model. A new single-sample method is presented, based on the 3-compartment model as reference standard.

Adolescent↗

PubMedDate not supplied

Lipopolysaccharide induces the expression of interleukin-1alpha distinctly in different compartments of term and preterm human placentae.

The aim of the study was to investigate the stimulatory effect of lipopolysaccharide (LPS) on IL-lalpha production in different compartments of term and preterm placental tissues. Homogenates from amnion, chorion, and from fetal (subchorionic placental tissues, maternal decidua, and mid-placental tissue before and after perfusion of isolated placental cotyledons of 5 term placentas and 4 placentas obtained after preterm birth (28-34 W of gestation) were examined. Isolated placental cotyledons were dually perfused LPS (100 ng/kg perfused placental tissue) was perfused into the maternal side during 10 hours. Homogenates of the samples were examined by ELISA for IL-1alpha levels, and paraffin sections of the samples were stained by immunohistochemical staining, to characterize the cellular origin of placental IL-1alpha. Paired t test and ANOVA determined statistical significance. In the homogenates, there was a tendency towards higher IL-lalpha levels in all preterm placental compartments as compared to the term compartments before perfusion. A significant increase was observed only in the chorion compartment (p = 0.035). LPS had significantly increased IL-la levels only in the decidua compartment of term placentas as compared to other placental compartments (p = 0.0004), and had decreased IL-1alpha levels in the mid-placenta (p = 0.034). In preterm placentas, addition of LPS did not affect the expression levels of IL-1alpha in either fetal or maternal compartments as determined by ELISA and immunohistochemical staining. IL-la levels in the chorion compartment of preterm placenta were significantly higher as compared to term placenta. LPS affects placental tissues of term and preterm placentas differently. Also, in the term placentas, LPS affected the different compartments differently. Thus, IL-1alpha may have a key role (as a autocrine/paracrine factor) in the regulation of normal and pathological pregnancy and parturition.

Autocrine Communication↗

PubMed1986

Chemotactic peptide binding by rabbit polymorphonuclear leukocytes. Presence of two compartments having similar affinities but different kinetics.

N-Formylnorleucylleucylphenylalanine (f-Nle-LeuPhe) bound to rabbit peritoneal polymorphonuclear leukocytes at 4 degrees C exists in at least two compartments that can be differentiated by their off rates. The off rate of one compartment is similar to that of the receptor characterized previously, about 0.4 min-1 (Aswanikumar, S., Corcoran, B., Schiffmann, E., Day, A. R., Freer, R. J., Showell, H. J., Becker, E. L., and Pert, C. B. (1977) Biochem. Biophys. Res. Commun. 74, 810-817; Sullivan, S. J., and Zigmond, S. H. (1980) J. Cell Biol. 85, 703-711); the off rate of the second compartment is about 0.005 min-1. Lysis of the cells at 4 degrees C with 1% Triton does not affect the peptide release from either compartment. Accumulation of peptide at 4 degrees C into the fast off-rate compartment is rapid, reaching a plateau in about 5 min, while peptide in the slow off-rate compartment continues to increase for up to 4 h. The rate of accumulation in the slow off-rate compartment is approximately proportional to the amount of peptide bound to the fast off-rate compartment. Cells lysed at 4 degrees C before binding are still able to accumulate peptide into both compartments. Three possible models to explain the data are presented.

Animals↗

PubMed1981

[Post-traumatic compartment syndrome of the leg (author's transl)].

Fifteen compartment syndromes seen in the first few hours have been collected. Fourteen occurred after tibial fracture and one after a simple contusion. In typical cases it is emphasised that ischaemia affects the contents of the compartment in an insular fashion so that distal ischaemia is not present. The main arteries are sound and demonstrated by distal pulses, the vascularity of the foot, Doppler studies and arteriography. The diagnosis is difficult but must be made at the earliest opportunity by repeated clinical examination. Measurement of the compartment pressure may be useful because the decision for fasciotomy has to be made with some urgency. The critical delay for the anterior compartment is about 12 h following trauma but it is much longer for the posterior compartment. We believe that it is advisable to always perform both anterior and posterior fasciotomy. Seven cases had combined involvement. Necrotic muscle is excised, particularly if it is present in the posterior compartment, because of the risk of contracting fibrosis. In the anterior compartment, the fibrosis can be helpful and reduce the effects of foot drop. Cases in the literature have most often been associated with conservatively treated fractures. We have measured compartment pressures during intramedullary nailing. An increase in pressure is often recorded when the nail is introduced but returns to normal in a few minutes.

Adolescent↗

PubMed1986

Chronic anterior-compartment syndrome of the leg. Results of treatment by fasciotomy.

Thirty legs in nineteen patients, eleven with bilateral and eight with unilateral chronic anterior-compartment syndrome, were treated by fasciotomy. In addition, five of these patients (six legs) had compression of the superficial peroneal nerve: two before and three after fasciotomy. One patient also had lateral compartment syndrome in one leg. The patients who had compression of the superficial peroneal nerve were relieved by partial fasciectomy and fasciotomy of the lateral compartment. In one of these patients, with bilateral nerve compression, both superficial peroneal nerves were anomalous. The patient who had lateral compartment syndrome was relieved by fasciotomy of this compartment. Two patients required a second fasciotomy due to recurrence of the chronic compartment syndrome. At an average length of follow-up of twenty-five months after fasciotomy for anterior compartment syndrome, functional capacity was unlimited or increased in eighteen patients (twenty-eight legs) and was unchanged in one patient (two legs) who had had compression of the superficial peroneal nerve. The intramuscular pressures in the anterior compartment were normal at rest as well as during and after exercise eight months after the original fasciotomy in twenty-eight legs and eight months after the second fasciotomy in two legs.

Adolescent↗

PubMed1983

Results of fasciotomy in patients with medial tibial syndrome or chronic anterior-compartment syndrome.

I studied the results of fasciotomy of the affected muscle compartment in eight patients with chronic anterior-compartment syndrome (involvement of the anterior tibial compartment) and in nine patients with medial tibial syndrome (involvement of the deep posterior compartment), all of whom had pain with exercise. In the patients with chronic anterior-compartment syndrome, the preoperative intramuscular pressure in the anterior tibial compartment, as measured by the wick-catheter method, was increased ten minutes after exercise to 52 +/- 36 millimeters of mercury. After fasciotomy this pressure was significantly lowered to 4 +/- 6 millimeters of mercury (p less than 0.01). In the patients with medial tibial syndrome, the preoperative intramuscular pressure in the deep posterior compartment was normal ten minutes after exercise (8 +/- 4 millimeters of mercury) and did not significantly change after the fasciotomy (5 +/- 6 millimeters of mercury). The clinical results after fasciotomy were good in both groups of patients. There was complete relief of pain in all of the patients with chronic anterior-compartment syndrome and in five of the nine patients with medial tibial syndrome. The other four patients considered their condition to be improved in spite of some remaining symptoms.

Adolescent↗

PubMed2004

MR imaging of compartment syndrome of the lower leg: a case control study.

The aim of this study was to evaluate the use of MR imaging for diagnosis and therapy management of compartment syndromes. In total, 15 patients (5 with an imminent compartment syndrome and 10 with manifest compartment syndrome) underwent MR imaging with a variety of pulse sequences including fat suppression, magnetization transfer imaging, and intravenous gadopentetate dimeglumine (Gd-DTPA) administration. Early and late follow-up MR images were obtained. Manifest compartment syndromes showed swollen compartments with loss of normal muscle architecture on T1-weighted spin-echo images. T2-weighted spin-echo and magnetization transfer imaging showed bright areas, which enhanced after Gd-DTPA. Early follow-up showed changes in enhancement patterns; late follow-up showed fibrosis and cystic and fatty degenerations of the affected compartments. MR imaging can help make the diagnosis of a manifest compartment syndrome in clinically ambiguous cases. It points out the affected compartments and allows the surgeon to selectively split the fascial spaces.

Adolescent↗

PubMed2006

Compartment syndrome of the lower leg after surgery in the modified lithotomy position: report of seven cases.

PURPOSE: Acute compartment syndrome is known to develop after trauma or after postischemic revascularization. It also can occur when a patient has been lying in the lithotomy position during prolonged surgery. Methods were searched for the prevention of this iatrogenic complication after a series of seven patients who developed compartment syndrome after surgery at our hospital. METHODS: A series of seven consecutive patients who developed compartment syndrome of the lower leg(s) after abdominoperineal surgical procedures from 1997 to 2002 is presented and so are the lessons learned to prevent this problem. RESULTS: When comparing our experiences with data from literature, the seven patients had the usual risk factors for development of a compartment syndrome: lengthy procedure (>5 hours); decreased perfusion of the lower leg because of Trendelenburg positioning combined with the lithotomy position; and external compression of the lower legs (because of positioning, stirrups, or antiembolism stockings). Measures have been taken to prevent compartment syndrome from developing after prolonged surgery in the lithotomy position. This complication has not occurred again after the introduction of these measures two years ago. CONCLUSIONS: Acute compartment syndrome can be prevented if adequate measures are taken, but after lengthy surgery, maximum alertness for emerging acute compartment syndrome remains indicated. Early diagnosis and treatment by four-compartment fasciotomy is still the only way to prevent irreversible damage.

Acute Disease↗

PubMed1995

Magnetic resonance imaging verification of a multi-compartment perfusion model for a chromatography gel phantom.

A model of MRI signal intensity was developed for chromatography column phantoms containing Sephadex gels, which were used to simulate tissue perfusion and the exchange of protons between extravascular and intravascular tissue compartments. Computer simulations of two-compartment and three-compartment models were compared in experiments that used two chromatography columns. One column contained a Sephadex G-25 gel that had a smaller pore size and a slower rate of exchange between extrabead and intrabead compartments than did a second column, which contained a G-50 gel with a larger pore size. In both columns the beads were of approximately the same size to simulate the same ratio of intrabead volume to extrabead volume. Slice-selective spin-echo experiments were performed with the columns oriented parallel to each other in a 1.5 T imager and parallel to the magnetic field, with water flowing through each column perpendicular to the slice at mean flow velocities ranging between 0 and 0.66 mm/s. The results of the experiments agreed with computer simulations, which showed that the MRI signal intensity in the perfused columns is a function of the rate of exchange between extrabead and intrabead compartments. The exchange process modifies the transit time of protons passing through an excited region. The simulations also showed that both two-compartment and three-compartment models could be used to fit the experimental data. Experiments with chromatography gel columns are a preliminary investigation into the potential of using MRI to measure the exchange between extravascular and intravascular compartments of endogenous protons during blood perfusion of biological tissue.

Body Fluid Compartments↗

PubMed2004

[Exercise-induced acute bilateral isolated anterolateral compartment syndrome of the leg: a case report of a rare condition].

Acute compartment syndrome of the leg is generally a consequence of trauma. Exercise-induced acute compartment syndrome of the leg is an exceptional clinical entity observed in the context of a chronic compartment syndrome or as an isolated acute syndrome subsequent to an intense effort. Our patient was a young athlete with no history of exercise-induced leg pain. Following a soccer game, he developed an acute leg syndrome involving the anterolateral compartment of both legs. The diagnosis was not suggested by the patient's history (no notion of chronic compartment syndrome) nor the natural history of the condition but was retained on the basis of the clinical presentation and course then confirmed by intramuscular pressure measurements. Emergency treatment by fasciotomy under general anesthesia in the operating room led to cure with no sequela. The fasciotomy was closed on day 9 with simple skin sutures. Surgeons should be aware that acute exercise-induced compartment syndrome (with the risk of severe functional consequences) may be the cause of unexplained intense leg pain. The diagnosis is established on the basis of clinical findings and measurement of intramuscular pressures. Pain is the cardinal sign, sometimes associated with sensorial deficit. The compartment is hard and painful at palpation. Passive stretching exacerbates the pain. Compartment pressure is required for certain diagnosis, most Authors accepting > 30mmHg as a positive test. Emergency fasciotomy is required.

Acute Disease↗

PubMed1998

The compartments of the hand: an anatomic study.

To determine the nature and number of enclosed myofascial spaces in the hand, an anatomic study that included 21 cadaver hands was conducted using a gelatin injection method. Data were collected from the prepared cross-sections of each specimen. The results showed the thenar space to comprise 2 or more discrete compartments in 52% of the hands. In 76% of the specimens, the hypothenar space demonstrated at least 2 compartments. The adductor pollicis and first dorsal interosseous muscles were discrete compartments in 71% of the hands. The interosseous compartments demonstrated significant variability. The dorsal and palmar interosseous muscles were discrete compartments within the second interosseous compartment in 48% of the hands, within the third interosseous compartment in 67%, and within the fourth interosseous compartment in 33%. Subcompartmentalization of the enclosed myofascial spaces of the hand should be anticipated in cases requiring fasciotomy. Thorough inspection within anatomic areas or generous release of the muscular origin along the metacarpal at the time of fasciotomy is suggested to ensure complete inspection.

Cadaver↗

PubMed2002

Prospective study of the incidence and outcome of intra-abdominal hypertension and the abdominal compartment syndrome.

BACKGROUND: Intra-abdominal hypertension has been recognized as a source of morbidity and mortality in the traumatized patient following laparotomy. Multiple organ dysfunction attributable to intra-abdominal hypertension has been called the abdominal compartment syndrome. The epidemiology and characteristics of these processes remain poorly defined. METHODS: Intra-abdominal pressure was measured prospectively in all patients admitted to a trauma intensive care unit over 9 months. Data were gathered on all patients with intra-abdominal hypertension. RESULTS: Some 706 patients were evaluated. Fifteen (2 per cent) of 706 patients had intra-abdominal hypertension. Six of the 15 patients with intra-abdominal hypertension had abdominal compartment syndrome. Half of the patients with abdominal compartment syndrome died, as did two of the remaining nine patients with intra-abdominal hypertension. Patients with abdominal compartment syndrome had a mean intra-abdominal pressure of 42 mmHg compared with 26 mmHg in patients with intra-abdominal hypertension only (P < 0.05). CONCLUSION: The incidence of intra-abdominal hypertension and abdominal compartment syndrome was 2 and 1 per cent respectively. Intra-abdominal hypertension did not necessarily lead to abdominal compartment syndrome, and often resolved without clinical sequelae. Abdominal compartment syndrome did not occur in the absence of earlier laparotomy. Abdominal compartment syndrome was associated with a marked increase in intra-abdominal pressure (above 40 mmHg).

Adolescent↗

PubMed2004

Clinical spectrum of acute compartment syndrome of the thigh and its relation to associated injuries.

The reason for the described clinical variability of acute compartment syndrome of the thigh, with high morbidity and mortality in some patients and an uncomplicated clinical course in others, is not known. To better define the clinical spectrum and factors determining the clinical course of this rare clinical entity, we did a retrospective multicenter study of 28 patients with 29 thigh compartment syndromes. The leading cause of acute thigh compartment syndrome was blunt trauma from motor vehicle accidents (46%) or contusion (39%). Pain with passive motion was present in all patients who were conscious, followed by paresthesia (60%), and paralysis (42%). The anterior compartment was involved most frequently with mean compartment pressure of 58 +/- 3 mm Hg. Myonecrosis, sepsis, and need for skin grafting were observed more frequently in patients with ipsilateral femur fracture. Only 7% of patients with isolated thigh compartment syndromes had short-term complications compared with 57% of patients with ipsilateral femur fractures. The incidence of complications correlated with the time to fasciotomy. Mortality was limited to patients with high injury severity scores. The clinical spectrum of thigh compartment syndrome is comparable with that of other compartment syndromes and its clinical course is determined by its associated injuries.

Acute Disease↗

PubMed2005

Treatment of compartment syndrome: transverse fasciotomy as an adjunct to longitudinal dermatofasciotomy: an in vitro study.

OBJECTIVE: This study describes a previously unpublished technique for compartment release that combines adjunctive transverse fasciotomies with a limited longitudinal dermatofasciotomy and compares its efficacy with a standard extensile longitudinal dermatofasciotomy. DESIGN: Limited 10-cm longitudinal dermatofasciotomies were performed bilaterally on 14 cadaveric specimens (28 legs). Next, we performed transverse fasciotomies on 1 limb and performed extensions of the longitudinal incision on the contralateral limb. Subsequent changes in compartment pressures were recorded after each release. Two-tailed paired and unpaired Student t tests were performed for statistical analysis with significance set at P < 0.05. SETTING: Anatomy laboratory. RESULTS: After a 10-cm longitudinal dermatofasciotomy, the average compartment pressure was 17 +/- 7.1 mm Hg proximally and 15.5 +/- 7.4 mm Hg distally. With an extensile 16-cm longitudinal incision, a significant decrease in compartment pressure was seen both proximally (6.5 +/- 3.1 mm Hg) and distally (4.7 +/- 4.7 mm Hg). With adjunctive transverse fasciotomies, a significant reduction in compartment pressure also was observed proximally (6.9 +/- 6.1 mm Hg) and distally (6.1 +/- 5.4 mm Hg). There was no statistically significant difference in compartment pressures between an extensile 16-cm incision and 10-cm incision combined with transverse fasciotomies both proximally and distally (P = 0.84 and P = 0.5, respectively). CONCLUSIONS: A combined approach of transverse fasciotomies with a limited longitudinal dermatofasciotomy in this in vitro compartment syndrome study is as effective as a standard 16-cm longitudinal release in the anterior compartment of this cadaveric leg model.

Anterior Compartment Syndrome↗

PubMed2005

Abdominal compartment syndrome.

PURPOSE OF REVIEW: This review will set forth the new consensus definitions for intra-abdominal pressure, intra-abdominal hypertension, and the abdominal compartment syndrome from the World Congress on the Abdominal Compartment Syndrome in December 2004. The review will explore the challenges in diagnosis, pathophysiology, and recent concepts in the treatment of abdominal compartment syndrome. RECENT FINDINGS: Intra-abdominal pressure greater than 12 mm Hg may exert adverse physiologic sequelae, progressing to intra-abdominal hypertension and full-blown abdominal compartment syndrome as intra-abdominal pressure increases. The first challenge is to recognize that abdominal compartment syndrome may be a potential problem in critically ill patients. Intra-abdominal pressure monitoring is essential for this. Continuous monitoring of intra-abdominal pressure and abdominal perfusion pressure adds real-time measurements and can be performed by way of the stomach or bladder. Intra-abdominal hypertension occurs in approximately 35% of patients in the intensive care unit, and abdominal compartment syndrome in approximately 5%. SUMMARY: Massive resuscitation is increasingly recognized as a major contributor to abdominal compartment syndrome. Prophylactic decompression and temporary abdominal closure have important roles in preventing tertiary or recurrent abdominal compartment syndrome. Failure to recognize and treat intra-abdominal hypertension will result in increased risk of renal impairment, visceral and intestinal ischemia, respiratory failure and death.

Abdomen↗