Intravital fluorescence microscopy was applied to the livers of male Wistar rats to test the hypothesis that complement mobilization stimulates Kupffer cells and subsequently initiates hepatic injury after hindlimb ischemia/reperfusion (I/R). Following 3 h of limb reperfusion, hepatocellular viability (serum levels of alanine transaminase and cell death via propidium iodide labeling) decreased significantly from levels in sham-operated animals. Inhibition of complement mobilization with soluble complement receptor type 1 (20 mg/kg body wt) and interruption of Kupffer cell function with GdCl(3) (1 mg/100g body wt) resulted in significant hepatocellular protection. Although the effects of hindlimb I/R on hepatic microvascular perfusion were manifest as increased heterogeneity, both complement inhibition and suppression of Kupffer cell function resulted in marked improvements. No additional hepatocellular protection and microvascular improvements were provided by combining the interventions. Furthermore, inhibition of complement mobilization significantly depressed Kupffer cell phagocytosis by 42% following limb reperfusion. These results suggest that the stimulation of Kupffer cells via complement mobilization is necessary but is not the only factor contributing to the early pathogenesis of hepatic injury following hindlimb I/R.

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Significant vascular complications are rare following systemic infections with Mycobacterium tuberculosis (TB). This report describes a 33-year-old man who presented with a short history of abdominal discomfort and febrile episodes with no prior history of infection with TB. Ultrasound, CT scan, and aortography confirmed the presence of a pseudoaneurysm originating from the posterior aspect of the supraceliac aorta at the level of the diaphragm. Via a full thoracoabdominal approach, periaortic inflammatory tissue and the aortic wall itself were debrided, and repair of the pseudoaneurysm was achieved with a synthetic patch. Mycobacterium tuberculosis was isolated from the aortic wall, and anti-TB medications were instituted. Postoperatively the patient did well and was discharged after 14 days. As illustrated by this case, tuberculous mycotic aneurysms of the aorta are optimally treated with a combination of medical and surgical therapy, and early diagnosis is essential to ensure survival.