Prevalence of life-sustaining treatment limitations in Polish very old intensive care patients (VIPs). A post-hoc analysis of two prospective observational studies

PURPOSE

Several initiatives have recently focused on raising awareness about limitations of treatment in Poland. We aimed to assess if the propensity to limit LST among elderly patients in 2018-2019 increased compared to 2016-2017.

METHODS

We analysed Polish cohorts from studies VIP1 (October 2016 - May 2017) and VIP2 (May 2018 - May 2019) that enrolled critical patients aged >80. We collected data on demographics, clinical features limitations of LST. Primary analysis assessed factors associated with prevalence of limitations of LST, A secondary analysis explored differences between patients with and without limitations of LST.

RESULTS

601 patients were enrolled. Prevalence of LST limitations was 16.1% in 2016-2017 and 20.5% in 2018-2019. No difference was found in univariate analysis (p = 0.22), multivariable model showed higher propensity towards limiting LST in the 2018-2019 cohort compared to 2016-2017 cohort (OR 1.07;95%CI, 1.01-1.14). There was higher mortality and a longer length of stay of patients with limitations of LST compared to the patients without limitations of LST. (11 vs. 6 days, p = 0.001).

CONCLUSIONS

The clinicians in Poland have become more proactive in limiting LST in critically ill patients ≥80 years old over the studied period, however the prevalence of limitations of LST in Poland remains low.

The association of prior paracetamol intake with outcome of very old intensive care patients with COVID-19: results from an international prospective multicentre trial

BACKGROUND

In the early COVID-19 pandemic concerns about the correct choice of analgesics in patients with COVID-19 were raised. Little data was available on potential usefulness or harmfulness of prescription free analgesics, such as paracetamol. This international multicentre study addresses that lack of evidence regarding the usefulness or potential harm of paracetamol intake prior to ICU admission in a setting of COVID-19 disease within a large, prospectively enrolled cohort of critically ill and frail intensive care unit (ICU) patients.

METHODS

This prospective international observation study (The COVIP study) recruited ICU patients ≥ 70 years admitted with COVID-19. Data on Sequential Organ Failure Assessment (SOFA) score, prior paracetamol intake within 10 days before admission, ICU therapy, limitations of care and survival during the ICU stay, at 30 days, and 3 months. Paracetamol intake was analysed for associations with ICU-, 30-day- and 3-month-mortality using Kaplan Meier analysis. Furthermore, sensitivity analyses were used to stratify 30-day-mortality in subgroups for patient-specific characteristics using logistic regression.

RESULTS

44% of the 2,646 patients with data recorded regarding paracetamol intake within 10 days prior to ICU admission took paracetamol. There was no difference in age between patients with and without paracetamol intake. Patients taking paracetamol suffered from more co-morbidities, namely diabetes mellitus (43% versus 34%, p < 0.001), arterial hypertension (70% versus 65%, p = 0.006) and had a higher score on Clinical Frailty Scale (CFS; IQR 2-5 versus IQR 2-4, p < 0.001). Patients under prior paracetamol treatment were less often subjected to intubation and vasopressor use, compared to patients without paracetamol intake (65 versus 71%, p < 0.001; 63 versus 69%, p = 0.007). Paracetamol intake was not associated with ICU-, 30-day- and 3-month-mortality, remaining true after multivariate adjusted analysis.

CONCLUSION

Paracetamol intake prior to ICU admission was not associated with short-term and 3-month mortality in old, critically ill intensive care patients suffering from COVID-19.

TRIAL REGISTRATION

This prospective international multicentre study was registered on ClinicalTrials.gov with the identifier "NCT04321265" on March 25, 2020.

Growing Season, Cultivar, and Nitrogen Supply Affect Leaf and Fruit Micronutrient Status of Field-Grown Kiwiberry Vines

The N uptake can affect kiwiberry yield and quality; however, the relationship between an increasing N dose and micronutrient accumulation in leaves and fruit is still to be elucidated. Interrelationships between essential nutrients are one of the most important issues in terms of effectiveness in plant mineral nutrition. A pattern in leaf nutrient accumulation throughout the growing period is required to indicate a suitable sampling time for the purpose of nutrient diagnostics and controlled plant feeding. The experiment was conducted on two commercially available cultivars of kiwiberry, 'Weiki' and 'Geneva', during the 2015-2016 growing seasons with an increasing soil N fertility (30-50-80 mg N kg^-1 soil DW) to test the relationship between soil N level and leaf/fruit micronutrient concentration. The leaf Zn, Cu, Fe, and Mn concentrations significantly increased with a higher N supply in 'Geneva', while in 'Weiki' only Mn increased. Leaf B, Fe, and Mn gradually increased throughout the growing season, while Cu decreased. Between mid-July and the beginning of August, the lowest fluctuations in the micronutrient contents were recorded. The effect of the growing season on leaf micronutrient accumulation was highly significant; except for Fe, significantly higher micronutrient levels were revealed in 2016. Compared to the leaves, the growing season effect was smaller in the case of fruit micronutrient concentrations. Irrespective of cultivar, the increase in N fertilization resulted in a higher fruit Mn concentration and was insignificant in the case of other micronutrients. The results indicate that the N dose may affect the accumulation of micronutrients within a certain range depending on the tissue type and the genotype.

Frailty is associated with long-term outcome in patients with sepsis who are over 80 years old: results from an observational study in 241 European ICUs

BACKGROUND

Sepsis is one of the most frequent reasons for acute intensive care unit (ICU) admission of very old patients and mortality rates are high. However, the impact of pre-existing physical and cognitive function on long-term outcome of ICU patients ≥ 80 years old (very old intensive care patients (VIPs)) with sepsis is unclear.

OBJECTIVE

To investigate both the short- and long-term mortality of VIPs admitted with sepsis and assess the relation of mortality with pre-existing physical and cognitive function.

DESIGN

Prospective cohort study.

SETTING

241 ICUs from 22 European countries in a six-month period between May 2018 and May 2019.

SUBJECTS

Acutely admitted ICU patients aged ≥80 years with sequential organ failure assessment (SOFA) score ≥ 2.

METHODS

Sepsis was defined according to the sepsis 3.0 criteria. Patients with sepsis as an admission diagnosis were compared with other acutely admitted patients. In addition to patients' characteristics, disease severity, information about comorbidity and polypharmacy and pre-existing physical and cognitive function were collected.

RESULTS

Out of 3,596 acutely admitted VIPs with SOFA score ≥ 2, a group of 532 patients with sepsis were compared to other admissions. Predictors for 6-month mortality were age (per 5 years): Hazard ratio (HR, 1.16 (95% confidence interval (CI), 1.09-1.25, P < 0.0001), SOFA (per one-point): HR, 1.16 (95% CI, 1.14-1.17, P < 0.0001) and frailty (CFS > 4): HR, 1.34 (95% CI, 1.18-1.51, P < 0.0001).

CONCLUSIONS

There is substantial long-term mortality in VIPs admitted with sepsis. Frailty, age and disease severity were identified as predictors of long-term mortality in VIPs admitted with sepsis.

COVID-19 and haemodynamic failure: a point of view on mechanisms and treatment

The SARS-CoV-2-related disease has an undoubted impact on the healthcare system. In the treatment of severe COVID-19 cases, the main focus is on respiratory failure. However, available data suggest an important contribution of haemodynamic impairment in the course of this disease. SARS-CoV-2 may affect the circulatory system in various ways that are universal for septic conditions. Nonetheless, unique features of this pathogen, e.g. direct insult leading to myocarditis and renin-angiotensin-aldosterone axis dysregulation, must be taken into account. Although current recommendations on COVID-19 resemble previous septic shock guidelines, special attention to haemodynamic monitoring and treatment is necessary. Regarding treatment, one must take into account the potential profound hypovolaemia of severe COVID-19 patients. Pharmacological cardiovascular support should follow existing guidelines and practice. Interesting concepts of decatecholaminisation and the effect of vasopressors on pulmonary circulation are also presented in this review on COVID-19-related haemodynamic failure.

Bioactive compounds, total antioxidant capacity and yield of kiwiberry fruit under different nitrogen regimes in field conditions

BACKGROUND

Actinidia arguta known as the 'kiwiberry' or 'mini kiwi' is relatively new among the cultivated berry species. Recent studies indicate the kiwiberry fruit could be an important source of many health-promoting compounds. A knowledge-based fertilisation concept was evolved to define optimal strategies for feeding Actinidia with nitrogen (N) because a deficit and excess of N both have a negative impact on plants and the surrounding environment.

RESULTS

Kiwiberry yield and fruit internal quality significantly depended on soil N level, cultivar and growing season. A higher soil N led to an increase in carotenoid content and a decrease in phenolic content, whereas ascorbic acid and glutathione contents were not affected by soil N fertility. Under the highest N dose, enzymatic antioxidants were activated. Trolox equivalent antioxidant capacity clearly decreased with an increasing N level.

CONCLUSIONS

Competent and skilful fertilisation management should focus on balancing a high fruit yield and maintaining their high quality. Based on yield level and fruit antioxidant potential, the N guide values for A. arguta vary between 30 and 50 mg N per kg^-1 of soil. The recommended N dose may depend on overall soil quality traits and cultivar N demand, as well as on weather conditions. © 2020 Society of Chemical Industry.

Portal hypertension as a result of the incomplete surgically treated advanced alveolar echinococcosis: a case description

Background

Infection of Echinococcus multilocularis causes in humans the alveolar echinococcosis. Although the infection has world-wide distribution it is rarely detected. Diagnosis of alveococcosis is difficult because of not typical clinical picture and irregular results of radiological examinations suggesting neoplasmatic process which begins in the liver tissue or in the biliary tracts. The parasitic growth is slow, so the illness is quite often established in late invasion period. Treatment of long-lasting and late diagnosed infection is difficult and requires cooperation of parasitologists together with surgeons to avoid life-threatening organ dysfunction.

Case presentation

We describe a young male patient, diagnosed, according to the radiological, immunological and histological examination results, infection of Echinococcus multilocularis, who was treated with not radical resection of pathologic mass together with persistent albendazole intake. The right hepatectomy was performed. In addition, visible cysts were removed from the left lobe of the liver in nonanatomical resection and suspicious calcified lesions in hepatoduodenal ligament were also removed. After the operation portal hypertension, with splenomegaly and symptoms of the liver cirrhosis occurred (thrombocytopenia, collateral venous circulation, first degree varices oesophagii). The portal hypertension probably could be a result of incomplete surgery due to extended parasitic infection and liver anathomical changes due to performed procedures, because the portal hypertension and it’s further complications had not been observed before the operation.

Conclusions

Echinococcus multilocularis should be taken under consideration in differential diagnosis of irregular lesions within the liver. Lon-lasting invasion could be responsible for the irreversible secondary liver changes such as cirrhosis and portal hypertension. The surgery treatment (treatment of choice) is difficult and it’s results depends on the invasion period the patient is operated on. After the surgery the patient requires careful follow – up, to detect early complications.

Frailty is associated with an increased mortality among patients ≥ 80 years old treated in Polish ICUs

BACKGROUND

The increasing population of very old intensive care patients (VIPs) is a major challenge currently faced by clinicians and policymakers. Reliable indicators of VIPs' prognosis and purposefulness of their admission to the intensive care unit (ICU) are urgently needed.

METHODS

This is a report from the Polish sample of the VIP1 multicentre cohort study (NCT03134807). Patients ≥ 80 years of age admitted to the ICU were included in the study. Information on the type and reason for admission, demographics, utilisation of ICU procedures, ICU length of stay, organ dysfunction and the decision to apply end-of-life care was collected. The primary objective was to investigate the impact of frailty syndrome on ICU and 30-day survival of VIPs. Frailty was assessed with the Clinical Frailty Scale (≥ 5 points on a scale of 1-9).

RESULTS

We enrolled 272 participants with a median age of 84 (81-87) years. Frailty was diagnosed in 170 (62.5%) patients. The ICU and 30-day survival rates were equal to 54.6% and 47.3% respectively. Three variables were found to significantly increase the odds of death in the ICU in a multiple logistic regression model: SOFA score (OR = 1.16; 95%CI 1.16-1.24), acute mode of admission (OR = 5.1; 95%CI 1.67-15.57) and frailty (OR = 2.25; 95%CI 1.26-4.01).

CONCLUSION

Measuring frailty in critically ill older adults can facilitate making more informed clinical decisions and help avoid futile interventions.

A systematic review of calcium channel antagonists in bipolar disorder and some considerations for their future development

l-type calcium channel (LTCC) antagonists have been used in bipolar disorder for over 30 years, without becoming an established therapeutic approach. Interest in this class of drugs has been rekindled by the discovery that LTCC genes are part of the genetic aetiology of bipolar disorder and related phenotypes. We have therefore conducted a systematic review of LTCC antagonists in the treatment and prophylaxis of bipolar disorder. We identified 23 eligible studies, with six randomised, double-blind, controlled clinical trials, all of which investigated verapamil in acute mania, and finding no evidence that it is effective. Data for other LTCC antagonists (diltiazem, nimodipine, nifedipine, methyoxyverapamil and isradipine) and for other phases of the illness are limited to observational studies, and therefore no robust conclusions can be drawn. Given the increasingly strong evidence for calcium signalling dysfunction in bipolar disorder, the therapeutic candidacy of this class of drugs has become stronger, and hence we also discuss issues relevant to their future development and evaluation. In particular, we consider how genetic, molecular and pharmacological data can be used to improve the selectivity, efficacy and tolerability of LTCC antagonists. We suggest that a renewed focus on LTCCs as targets, and the development of 'brain-selective' LTCC ligands, could be one fruitful approach to innovative pharmacotherapy for bipolar disorder and related phenotypes.

Environmental assessment of different dewatering and drying methods on the basis of life cycle assessment

Sewage sludge is an inevitable product of wastewater treatment in municipal wastewater plants and its amount has increased dramatically due to the growing number of sewage systems users. This sludge needs to be adequately treated in order to decrease its hazardous properties and any negative influence on the environment. In this paper, gate to gate analysis, on the basis of life cycle assessment (LCA), was carried out in order to compare the environmental impact of alternative ways of sludge processing employing a dewatering press and three different kinds of dryers - belt dryer, container dryer and batch dryer. SimaPro 7.2 software and Ecoinvent 2.2 database were used to estimate the carbon footprint and energy balance of these processes. The main energy consumption in the scenarios analyzed is caused by the drying process. The solution based on application of the batch dryer allows a saving of 39.6% of energy compared with the most energy-consuming solution using a belt dryer. Sludge processing using belt and container dryers cause greater environmental burdens.

In vitro sensitivity of leukemic cells to nucleoside derivatives in childhood acute leukemias: good activity in leukemic relapses

Nucleoside analogues such as fludarabine and cladribine are used in therapy of indolent lymphomas and leukemias in adults, while cytarabine is used mainly in protocols for acute leukemias. Mechanisms of their activity is based on inhibition of enzymes involved in DNA, RNA and protein synthesis. The objective of the study was the analysis of in vitro cellular drug sensitivity in childhood acute lymphoblastic (ALL) and myeloid (AML) leukemia. Isolated leukemic cells obtained from 264 patients, including 152 initial ALL, 45 relapsed ALL, 54 initial AML and 13 relapsed AML were tested for cytotoxicity for fludarabine, cladribine, and cytarabine by the MTT assay. Drug concentration lethal to 50% of tested cells was regarded as a value of drug resistance. Three tested nucleoside analogues showed highest cytotoxicity against initial ALL samples. Samples of relapsed ALL and initial AML were more resistant than ALL de novo ones. Unexpectedly, no differences were observed between initial and relapsed AML samples for all tested drugs, what suggests that nucleoside analogues are active drugs in relapsed AML, which is commonly regarded as a resistant disease. All tested drugs presented significant cross-resistance in each of analyzed subgroups. In summary, tested nucleoside analogues presented relatively good activity against childhood leukemias at relapse stage.

Human cystic and alveolar echinococcoses as indication to liver transplantation

The human cystic and alveolar echinococcoses are zoonotic diseases caused by larval stages of the tapeworms Echinococcus granulosus and E multilocularis. In man the liver form of the diseases develops most frequently. Recent epidemiological data indicate that the distribution of E multilocularis in the central Europe is wider than was previously anticipated; more cases of human alveococcosis during the last years have also been noted in Poland. In the present paper we analyzed several cases of human echinococcoses from Poland with respect to diagnosis and treatment as well as the indications for liver transplantation.

Comparison of the dot immunobinding assay and two enzyme-linked immunosorbent assay kits for the diagnosis of liver cystic echinococcosis

The dot immunobinding assay for the detection of hydatid antigen-specific antibodies (HA-DIA) was evaluated in patients with liver cystic and alveolar echinococcosis in comparison to two commercial ELISA kits. In 30 patients, E. granulosus infection (CE) was confirmed by histopathology or by the presence of parasite protoscoleces and/or hooks or specific antigen 5 (Ag5) in cyst fluid samples obtained by the fine needle aspiration biopsy (FNAB). Infection of E. multilocularis (AE) was diagnosed in two patients by the detection of specific anti-Em2(plus) ELISA and -Em18 Western blot antibodies and finally confirmed by histopathology. The HA-DIA using bovine hydatid antigens showed a high sensitivity in serum samples from CE patients; specific antibodies were found in 29 of 30 CE patients (96.7%). One negative result has been observed in a patient 2.6 years after radical surgery with a subsequent albendazole chemotherapy. The Echinococcosis ELISA(R) (Dialab Diagnostic) was positive in 23 CE cases (76.7%). The correlation between the HA-DIA and the Echinococcosis ELISA(R) was statistically significant. By contrast, Echinococcus granulosus IgG ELISA(R) (Bordier Affinity Products) gave positive results in only 12 of 30 CE patients (40.0%). Sera from two AE patients were high positive in all three methods analysed in our study. In non-endemic areas, due to the between-strains variations and differences in cyst immunogenic activity, related to the natural history of the parasite, a choice of an optimal method for a diagnosis of liver cystic echinococcosis has been discussed.The high diagnostic sensitivity and a faster one-step procedure, in comparison to traditional enzyme immunoassays, make the HA-DIA a very useful method for the diagnosis of CE in non-endemic areas, especially in a case of small or degenerating lesions and sterile echinococcal cysts with a low immunogenicity. The positive serology for CE frequently requires additional differentiation with E. multilocularis-specific antibodies.

[Analysis of the local synthesis of Toxoplasma gondii-specific immunoglobulins in the anterior eye chamber fluid. Report of two cases]

We reported two cases strongly suspected of ocular toxoplasmosis, in which a puncture of anterior eye chamber was performed for a final verification of clinical diagnosis. In both patients, fresh focal lesions of retinochoroiditis associated with old pigmented retinal scars were diagnosed. The 62-year-old women had a serological evidence of recently acquired T. gondii infection with an increasing IgG titre of a low avidity and a presence of specific IgM and IgA antibodies. In the 13-year-old girl, an immunological profile of the chronic infection was shown, confirmed by a high IgG avidity value. In the patient with a clinical picture of recurrent congenital toxoplasmosis, intraocular production of T. gondii-specific IgG was found in anterior eye chamber. The analysis of the specific antibodies synthesis in ocular fluid by the Western blot seems to be a valuable immunodiagnostic method for a final diagnosis of ocular toxoplasmosis.

[Evaluation of the postnatal treatment efficacy in congenital toxoplasmosis identified by the newborn screening programme]

The effectiveness of neonatal screening for anti-Toxoplasma IgM or IgA and IgM specific antibodies followed by an intensive anti-parasitic therapy for a prevention of clinical and immunological reactivations of congenital infection was studied. Thirty-five congenitally infected infants were included into clinical and serological follow-up. The children were mostly asymptomatic at birth or they expressed some non-specific reversible clinical abnormalities in neonatal period. Clinically overt toxoplasmosis occurred in 10 patients, including one infant with a severe form; 2 children had co-existing CMV infections. During the follow-up period, no clinical relapses were reported. Asymptomatic immunological rebounds of IgG or of IgG and IgA specific antibodies were observed in 16 patients. Anti-parasitic treatment initiated soon after birth seems to be promising in a prevention of early clinical sequelae of congenital T. gondii infection.

[Clinical value of Echinococcus granulosus--specific immunoglobulin G antibody avidity in liver cystic echinococcosis]

Role of E. granulosus-specific IgG antibody avidity in evaluation of a natural history of the parasite cysts in the liver, duration of infection and immunogenic cysts activity was studied. Thirty-one patients with liver cysts suspected of echinococcosis were examined; E. granulosus infection was finally confirmed by a fine needle aspiration biopsy or surgery in 29 cases (93.5%) and two non-parasitic simple cysts in the liver were diagnosed. E. granulosus-specific IgG antibody was found in 21 patients (67.7%). High IgG avidity values were observed in 14 patients with liver cysts in a degeneration stage confirmed by imaging techniques. Low IgG avidity values were mostly detected in children with hypoechogenic echinococcal cysts being in a recent stage of infection. Determination of anti-E. granulosus immunoglobulin G antibody avidity is a very usefull diagnostic tool for a determination of parasitic cysts activity and their developmental age.

Fine needle aspiration biopsy in the differential diagnosis of the liver cystic echinococcosis

Liver cystic echinococcosis (CE) in non-endemic areas poses several problems in the differential diagnosis of various space occupying lesions detected by US examination. Fine needle aspiration biopsy (FNAB) using teflon covered needles with a US visible marker may be very useful for the definitive diagnosis. In the Clinic of Parasitic and Tropical Diseases in Poznan, FNAB were performed in 121 patients with liver space occupying lesions, with an addition of an anthelmintic cover of albendazole. The biopsy material was examined parasitologically, cytologically, bacteriologically and immunologically. E. granulosus infection has been confirmed in 25 patients (20.6%), in 16 cases by finding parasite protoscoleces or hooks and in nine cases by detection of an antigen specific for E. granulosus, antigen 5 (Ag5). Additionally nine cases of malignancy (7.4%), four of angioma (3.3%) and three bacterial abscesses (2.5%) were diagnosed. There were no complications related to FNAB puncture. The algorithm of the clinical management of space occupying lesions suspected for CE was proposed. FNAB is a very important technique in the differential diagnosis of cystic echinococcosis.

Detection of specific Echinococcus granulosus antigen 5 in liver cyst bioptate from human patients

Eighty one liver cyst fluid samples obtained by fine needle aspiration biopsy (FNAB) in human patients were examined for specific E. granulosus antigen 5 (Ag5). The patients were suspected cases of hepatic cystic echinococcosis (CE) but protoscolices and hooks had not been found in the cyst bioptates. Presence of Ag5 was tested for using enzyme linked immuno-sorbent assay (ELISA) technique with monoclonal antibody against Ag5. Sensitivity of the test was approximately 1 ng of antigen/1 ml of examined fluid. Positive results were obtained in the control group of six patients having protoscolices and/or hooks in biopsy samples from liver cysts. Positive Ag5 results were also obtained in the samples from 89 fertile cysts and 28 sterile cysts originated from 15 naturally infected pigs as an experimental control group. Ag5 was present in nine cases (11.1%) out of 81 liver cyst fluid samples from suspected CE patients. In 25 human patients the sensitivity of the microscopic examination for protoscolices and/or hooks in FNAB material was 64% (16/25). In pig hydatid cysts the sensitivity of the microscopic examination for protoscolices and/or hooks in FNAB material was 86.5% and of the detection of Ag5-100%. In conclusion, examination of hepatic cyst biopsy samples for specific Ag5 resulted in increased detection of liver echinococcosis in human patients.

Molecular genetic analysis of human cystic hydatid cases from Poland: identification of a new genotypic group (G9) of Echinococcus granulosus

We have used nuclear (ribosomal ITS1) and mitochondrial (ND1) sequences to characterize human and pig isolates of Echinococcus granulosus collected by fine needle aspiration biopsy (FNAB) in Poland. The data indicate clearly that the Polish patients were not infected with the common sheep strain (G1 genotype) of E. granulosus, normally associated with human cystic hydatid infection. Instead, the hydatid parasite infecting the Polish patients shares very similar ND1 sequence with the previously characterized pig (G7) genotype but it also exhibits some clear differences. In particular, E. granulosus DNA from the Polish patients amplified a single ITS1 fragment in PCR and distinct ITS1-RFLP patterns were obtained after restriction digestion. The form of hydatid isolated from the Polish patients appears, therefore, to represent a distinct, previously undescribed genotype (designated G9) of E. granulosus.

[Delayed diagnosis of Trichinelliasis focused in the Poznan Province]

The study compares chronologically the weeks in which Trichinella spiralis infected meat was consumed. The first symptoms appeared and clinical diagnosis of trichinellosis was made in 37 patients. Several factors were responsible for the delay in final diagnosis of trichinellosis: widely distributed infected meat, contemporary common respiratory viral infections in population with fever and myalgia, diagnostic difficulties in the first index case.

Evaluating the activity of liver cystic echinococcosis using the delayed-hypersensitivity skin reaction to common antigens

When 11 patients with active liver cystic echinococcosis were tested with a commercial, delayed-hypersensitivity, skin test (DHST) to seven common antigens (Multitest; Merieux Institute, Lyon) they all reacted less than 30 patients with non-parasitic liver cysts, who had normal reactions. This immunosuppression in cystic echinococcosis was transient, as DHST performed within a few months of treatment were normal. DHST may help in evaluating the activity of Echinococcus granulosus cysts.

Pancreatic structure and function in the immature reserpinized rat

Immature rats were reserpinized to determine whether the model used for adults may be suitable for the study of pancreatic exocrine insufficiency seen in infants with cystic fibrosis. Rats were reserpinized by injections either into pregnant dams or into newborn rats. The dose of reserpine used by others was lethal to immature rats, so lower doses were used. Pancreas from 1-day-old fetal-treated pups was hypoplastic, but concentration of chymotrypsinogen was elevated. At age 7 days hyperplasia was seen. When rats were reserpinized as neonates, hypoplasia and decrease in all parameters measured was observed at age 7 days. Progressive recovery occurred during the following 2 weeks in both groups. Electron microscopic study of the fetal-treated 24-hr-old pancreas revealed evidence of acinar cell degeneration with the presence of abnormal zymogen granules. At age 7 days the pancreas from neonatal-treated rat pups appeared to have a reduced number of granules. At ages 14 and 21 days the pancreas was similar to that seen at age 7 days except that the granules were larger and some acinar lumina were filled with a finely granular, homogeneously dense material. It is concluded that prenatal and neonatal reserpinization of rats induces changes in pancreas similar to those found in cystic fibrosis.

Effects of cholecystokinin octapeptide and hydrocortisone on the development of fetal rat pancreas

Mechanisms and development of pancreas and pancreatic secretory function were studied in the rat. Injections of cholecystokinin octapeptide and hydrocortisone into pregnant rats altered pancreatic size, zymogen enzyme, and DNA content in the fetal newborn pancreas. These studies suggest that the developmental signals for pancreatic function may be related to endogenous release of cholecystokinin or hydrocortisone in the perinatal period.

Effects of hydrocortisone and cholecystokinin-octapeptide on neonatal rat pancreas

Hydrocortisone and cholecystokinin-octapeptide (CCK-8) were injected into newborn rats on days 1-5 of life. Both agents induced significant increases in pancreatic weight, protein, DNA, and specific activities of amylase, chymotrypsinogen, and lipase. The ability of the pancreas to secrete amylase in response to carbachol was decreased by the administration of hydrocorticosterone at age 7 days. CCK-8 increased basal secretion at 7 days. We conclude that growth and secretory capacity of the newborn rat pancreas are under the control of both glucocorticoids and cholecystokinin.

Maturation of secretory function in rat pancreas

In contrast to morphologic maturity, the newborn rat pancreas is unresponsive to carbachol. At 24 h, carbachol-stimulated secretion of exportable proteins markedly increases. Responsiveness to the calcium ionophore, A23187, is present at term. At age 24 h, pancreas from fasted newborn rats is also unresponsive to carbachol. When cholecystokinin octapeptide or hydrocortisone was administered to fasted newborn rats secretory function developed normally. Thus, responsiveness of newborn rat pancreas to secretagogues matures rapidly and can be induced by hormones.