Right ventricle dysfunction in patients with takotsubo syndrome

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Pol-tako

Background 

Takotsubo syndrome  (TTS) is a clinical condition that mimics acute myocardial infarction and is characterised by acute left ventricle dysfunction. However, right ventricle (RV) involvement can also occur. 

Purpose  

The aim of our study was to compare clinical characteristic, in-hospital complications and in-hospital mortality in patients with TTS with and without RV dysfunction. 

Methods  

209 consecutive patients with TTS were included in the study. Among them, 13,9% (29 patients) had RV dysfunction according to echocardiography evaluation. Clinical symptoms at admission to hospital was similar in both groups. There weren’t differences in time from onset of symptoms to the hospital admission in both groups. 

Results  

Patients with RV dysfunction was older (75,6 vs 69.4y). Left ventricle ejection fraction (LVEF) at 1st and 3rd day of hospitalisation was lower in patients with TTS with RV involvement in comparison to patients without RV dysfunction (37.9 vs 41.9%, 42,1 vs 47.3% and 46.1 vs 50.9%, respectively). However, at 5th day EF LV was similar in both groups. Tricuspid annular plane systolic excursion (TAPSE) was lower in patients with RV dysfunction at 1st and 3rd day (17 vs 21mm and 19 vs 21.6 mm, respectively). Pulmonary oedema and cardiogenic shock occurred less often in patients with RV involvement (6.9 vs 17.7% and 0 vs 4.4%). In hospital mortality was similar in both groups (3.4 and 2.2%).  Moreover, there was not difference in the length of hospitalisation (11.9 vs 10.1 days). 

Conclusions 

Right ventricle in patients with TTS can occur in about 14% patients. In addition to impaired RV function also LVEF is more depressed in the first days. However, in hospital mortality is similar.

Sex differences in patients with takotsubo syndrome

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Pol-tako

Introduction 

Takotsubo syndrome (TTS) is an acute revesible left ventricular dysfunction which occurs mainly in postmenopausal women. Despite the fact that the most patients with TTS are postmenopausal women and the possible patomechanism is related to female hormones, including estrogens, men also suffer from TTS. 

Objectives 

The goal of this study was to compare course of disease and prognoses in male and female patients with TTS. 

Patients and Methods 

The analysis included 210 patients (192 women and 18 men) hospitalized at the academic hospital from the year 2006 to 2020. 

Results 

Physical stress was trigger of TTS more often in men than women (50 vs. 38%). There were no differences in the frequency of risk factors and comorbidities, with the exception of higher prevalence of smoking in men. Markers of cardiac necrosis were similar in both groups.  At admission and peak NTproBNP levels were significantly more elevated in women (1527 vs. 3152 and 3752 vs. 5079pg/ml, respectively).  ST depression was found more frequently in men than in women (22 vs. 5%). Ejection fraction was lower among male patients at discharge (50 vs. 60%), despite the same length of hospitalization. Beta-adrenolytics and statins were more frequently prescribed for women than for men (90 vs 78% and 68 vs. 31%) whereas ACEI was prescribed in 96% men and 79% women. Moreover, there was P2Y12 inhibitors were more often used in men (33 vs 10.4%). In-hospital complications (arrhytmias, mechanical complications, cardiogenic shock) were similar in both groups. However, mortality rate was higher in women (3 vs. 0%).  

Conclusions 

Clinical course in patients with TTS is similar in women and men. However, in-hospital mortality was higher in women.

Pre-emptive analgesic effect of lornoxicam in mandibular third molar surgery: a prospective, randomized, double-blind clinical trial

The aim of this study was to establish whether the pre-emptive use of lornoxicam (16mg) in third molar surgery ensures successful postoperative analgesia and reduces rescue analgesic intake when compared to postoperative application, and in comparison with placebo. Ninety patients were split randomly into three groups: group A received lornoxicam 60min before surgery and placebo 60min after surgery; group B received placebo 60min before surgery and lornoxicam 60min after surgery; group C received placebo 60min before surgery and placebo 60min after surgery. Postoperative pain was recorded on a visual analogue scale and on a numerical rating scale at 1, 2, 4, 6, 8, 12, and 24h after surgery. The patients recorded total dose of paracetamol intake during the 24h after the procedure. The efficacy of postoperative analgesia was greater in lornoxicam groups when compared to the placebo group; there was no difference between the two lornoxicam groups (A and B). Patients in group C took their first rescue analgesic dose earlier after surgery than patients in the two lornoxicam groups. The average dose of paracetamol taken in group C was 1000mg, while it was500 mg in the lornoxicam groups.

Hyperkeratosis in human lower limb lymphedema: the effect of stagnant tissue fluid/lymph

BACKGROUND

Hyperkeratosis of skin in lower limb lymphedema is one of the sequelae of tissue fluid/lymph (TF/L) stasis, but its mechanisms remain unknown. It is noteworthy, nonetheless, that human TF/L contains high levels of growth factors and cytokines, and may serve as the physiological environment for keratinocyte (KC) proliferation.

OBJECTIVE

The aim of the study was to investigate the effect of human TF/L on human KC proliferation, differentiation and on the expression of epidermal stem cell markers on them.

METHODS

KC were isolated from lymphedema and normal skin, and cultured for 1-14 days in TF/L with neutralized Interleukin 1β, Interleukin 6, tumour necrosis factor α (TNF-α), keratinocyte growth factor (KGF) or tumour growth factor β (TGF-β). Alternatively, KC receptors for these factors were blocked.

RESULTS

The number of KC cultured in TF/L was increased, as was the percentage of mitotic figures. There was a higher percentage of p63, CD29, Ki67, PCNA, CK6, CK17, CK16 and a lower of CK10, CK14, filaggrin and involucrin-positive KC. Neutralization of TF/L IL-1β, IL-6, TNF-α and KGF as well as blockage of their receptors resulted in decreased percentage of mitotic KC. TGF-β had a limited effect on KC proliferation.

CONCLUSION

Hyperkeratosis in lymphedema may be the effect of a high concentration of cytokines in the stagnant TF/L tissue, but not because of presumed changes in the KC.

Transplantation of keratinocyte spore-like stem cells

BACKGROUND

Wound granulation tissue should be covered by epidermal cells migrating from the basal layer of the epidermis or hair "bulge" of the wound edge. However, new epidermal islands are frequently formed on the granulation tissue remote from the wound edge. Thus, current theory of "bulge"-originating stem cells does not necessarily correspond to the histological pictures of the healing wound. We took imprints of a leg ulcer surface and found single dispersed, large nucleated cells, some of them in mitosis. These cells resembled those from epidermal spinosum layer. The question arouse as to whether these cells might be the "spore-like" stem cells creating epidermal island. We found similarly shaped cells among the keratinocyte preserved in pulverized sodium chloride as the only surviving population in culture and revealing enzymatic activity. The aim of this work was to study whether the population of human keratinocytes surviving sodium chloride preservation and transplanted to SCID mice may form epidermis.

METHODS

The 12-month sodium chloride-preserved and cultured keratinocytes (KC) were transplanted to the wound on the dorsum of SCID mice for 14 and 21 days.

RESULTS

Ninety-five percent of cultured KC were enzymatically active "large" cells; they did not express p63 and CD29 claimed as specific for stem cells, and they did not proliferate. Transplanted to the center of the wound, they formed small KC islands and became confluent after 14 days.

CONCLUSIONS

The "large" epidermal keratinocytes survived the 12-month preservation in anhydrous sodium chloride. Transplanted to the wound, they formed epidermal islands of human phenotype. These cells may be the so-called "spore-like" stem cells.

Chronic lower limb wounds evoke systemic response of the lymphatic (immune) system

Wound healing should not be considered as a process limited only to the damaged tissues. It is always accompanied by an intensive local immune response and in advanced stages, the systemic lymphatic (immune) structure. In this review we present evidence from our own studies as well as pertinent literature on the role of skin and subcutaneous tissue lymphatics at the wound site and of transport of antigens along with collecting afferent lymphatics to the lymph nodes. We also speculate the role of lymph nodes in raising cohorts of bacterial and own tissue antigen-specific lymphocytes and their participation in healing and not infrequently evoking uncontrolled chronic immune reaction causing a delay of healing. It is also speculated as to why there is a rapid response of lymph node cells to microbial antigens and tolerance to damaged-tissue-derived antigens occurs

Pathways of lymph and tissue fluid flow during intermittent pneumatic massage of lower limbs with obstructive lymphedema

Questions remain on the use of sequential pneumatic compression including where does the fluid flow to and whether fluid can be moved to the non-swollen tissues of the hypogastrium and gluteal region? During pneumatic massage of the limb, we studied pathways of lymph and mobile tissue fluid flow using lymphoscintigraphy: a) from the calf and thigh across the inguinal region to the healthy non-swollen tissues of the hypogastrium and b) in the hypogastrium to the lateral and upper abdominal quadrants. To examine if there was effective fluid flow during pneumatic massage, plethysmographic flow measurements were also carried out. We demonstrated that: (i) pneumatic compression moved isotope in lymph remaining in functioning lymphatics and in tissue fluid in the interstitial space toward the inguinal region and femoral channel, (ii) there was no isotope crossing the inguinal crease or moving to the gluteal area, and (iii) isotope injected intradermally in the hypogastrium did not spread during manual massage to the upper and contralateral abdominal quadrants. In conclusion, intermittent pneumatic compression is effective in pushing mobile tissue fluid and relocating large fluid volumes toward the groin. However, the question that still remains is how to facilitate further flow toward the non-swollen tissues and thereby increase local absorption of fluid.

Influence of caprine arthritis-encephalitis virus infection on the activity of peripheral blood lymphocytes

Non-specific lymphocyte transformation assay using phytohemagglutinin (PHA) as a mitogen was applied to evaluate influence of caprine arthritis-encephalitis virus (CAEV) infection on activity of peripheral blood lymphocytes. Animals were selected for the CAEV-infected and CAEV-non-infected groups according to the results of two serological surveys carried out at one year interval, with the use of an ELISA test. In goats which were not infected with CAEV, lymphocytes stimulation index (SI) revealed a high diversity of the results with an mean value equal to 5.86 (minimum = 0.45, maximum = 40.00, SD = 8.40). SI values for infected goats reached the average of 1.10 (minimum = 0.46, maximum = 1.85, SD = 0.26). The difference between the average lymphocyte stimulation indices was statistically highly significant in both groups (p = 0.002) which could be an evidence of CAEV infection influence on lymphocyte reactivity. Regarding ELISA test as a "golden standard" the application of lymphocyte transformation assay in diagnosis of CAEV infection was assessed. The ROC curve was drawn. The area under the curve was only 0.324, which indicates very low accuracy of this method and limits its use for the diagnosis of the disease.

The effect of heterotypic infections of older horses with equine influenza virus type-2 on some clinical and immunological parameters

Twelve horses, all of them 10 years old, were vaccinated intramuscularly on 0 and 28 days of the experiment with inactivated vaccine containing only antigens of A-equi-2/Miami/63. Another three unvaccinated horses, each at the age of 10 years, were the negative control group. One, ten-year-old horse was vaccinated with commercial inactivated vaccine containing both antigens of A-equi-2/Miami/63 as well as A-equi-1/Praha/56 as positive control. Three horses were challenged intranasally with homotypic strain of Miami/63, while six other were challenged with heterotypic strains--three with Suffolk/89 and three with Kentucky/86. Three horses vaccinated with vaccine containing only strain A-equi-2/Miami/63 were not challenged. In the group of three unvaccinated horses, each one was challenged intranasally with different strains studied in this experiment. The horse vaccinated with commercial vaccine was not challenged. Replication of each strain was done in chick embryos. During the experiment blood from horses was collected for hematological and immunological examinations (antigen-specific and antigen-nonspecific lymphocyte transformation tests, lymphocyte immunophenotyping, antigen-specific leukocyte migration inhibition test and hemagglutination inhibition test). The statistical analysis showed that the dynamics of lymphocyte immunological reactivity in horses vaccinated with inactivated vaccine containing antigens of A-equi-2/Miami/63 in response to further antigen stimulation (in vitro) was different comparing the homotypic or nearly homotypic challenging with Miami/63 and Suffolk/89 respectively, to the more heterotypic one with the strain Kentucky/86. In horses challenged with classical homotypic strain of Miami/63 no clinical signs were observed. These results confirm that the vaccine shall consist of the strains currently circulating in the horse population.

Where do lymph and tissue fluid accumulate in lymphedema of the lower limbs caused by obliteration of lymphatic collectors?

Obliteration of lymphatic collecting trunks of limbs by infective processes, trauma, oncologic surgery and irradiation bring about retention of lymph and tissue fluid in tissues. Knowledge as to where excess lymph is produced and accumulates as tissue fluid is indispensable for rational physical therapy. So far, this knowledge has been based on lymphoscintigraphic, ultrasonographic and MR images. None of these modalities provides distinct images of dilated lymphatics and fluid expanded tissue spaces in dermis, subcutis and muscles. Only anatomical dissection and histological processing of biopsy material can demonstrate the remnants of the lymphatic network and the sites of accumulation of mobile tissue fluid. We visualized and calculated the volume of the "tissue fluid and lymph" space in skin and subcutaneous tissue of foot, calf, and thigh in various stages of lymphedema, using special coloring techniques in specimens obtained during lymphatic microsurgical procedures or tissue debulking. When the collecting trunks were obliterated, lymph was present only in the subepidermal lymphatics, while mobile tissue fluid accumulated in the spontaneously formed spaces in the subcutaneous tissue, around small veins, and in the muscular fascia. Deformation of subcutaneous tissue by free fluid led to formation of interconnecting channels. In obstructive lymphedema caused by obliteration of collectors, lymph is present mainly in subepidermal lymphatics, and the bulk of stagnant tissue fluid accumulates in subcutis between fibrous septa and fat globules as well as above and underneath muscular fascia. These observations provide useful clues for designing pneumatic devices and rational manual lymphatic massage to move stagnant tissue fluid toward the non-swollen regions.

Single-dose and multi-dose clindamycin therapy fails to demonstrate efficacy in preventing infectious and inflammatory complications in third molar surgery

The goal of this study was to evaluate the efficacy of single- and multi-dose (5-day) clindamycin therapy for the prevention of inflammatory complications in patients undergoing lower third molar surgical extraction with bone removal. Patients who qualified for the prospective, randomized, double-masked, placebo-controlled trial were randomly divided into three groups: (1) single dose of oral clindamycin administered preoperatively (single-dose group); (2) clindamycin administered preoperatively with continued therapy for 5 days (5-day group); and (3) a placebo group. The following parameters were evaluated on the first, second and seventh days postsurgery: trismus, facial swelling, body temperature, lymphadenopathy, alveolar osteitis and subjective pain sensations. There were 86 patients (31 in the single-dose group, 28 in the 5-day group and 27 in the placebo group) enrolled in the study. There were no statistically significant differences in postoperative inflammatory complications in patients during the first and second days postsurgery. A statistically significant variation in body temperature was reported on the seventh day. Analysis of the postoperative analgesic intake did not show statistically significant differences between examined groups. Clindamycin applied in a single preoperative dose of 600 mg with or without subsequent 5-day therapy does not demonstrate efficacy in prophylaxis for postoperative inflammatory complications after third molar surgery.

Some morphological, biochemical and immunological blood parameters in European bison with or without lesions in the digestive, respiratory, urinary and reproductive tracts

Ninety-seven bison (39 males and 58 females) were culled out during three successive winter seasons. No infection with BHV-1 and BHV-5 or other viruses was detected by PCR and SN methods. Advanced pathological lesions observed in males exhibiting symptoms of posthitis/balanoposthitis are probably due to secondary infection by microorganisms present in the prepuce (Corynebacterium spp., Bacillus spp., Fusobacterium necrophorum, Staphylococcus spp. (coagulase negative) and Staphylococcus hyicus). Histopathological examinations of sections from prepuce and lips of pudendum showed the presence of Onchocercinae nematode (Onchocerca sp.). A comparison of biochemical and morphological blood parameters in the bison with or without lesions in the digestive (presence of parasites), respiratory, urinary and reproductive tracts revealed that the most variable parameter during reproductive organ disorder is the leukocyte count, while disorders in the urinary and digestive tracts coincided with the age of animals. In cases of digestive disorder most changes were observed in the number of neutrophils and concentration of urea. The number of red blood cells, monocytes, the level of alkaline phosphatase (AP) and hematocrit negatively correlated with age. Negative correlation was also observed between the number of neutrophils, level of creatinine and lymphocyte proliferation index. However, positive correlation was seen between erythrocyte sedimentation rate (Spearman's correlation coefficient), level of alanine aminotransferase (ALT) and protein, and age of the bison. Positive correlation was also observed between the lymphocyte count and lymphocyte proliferation index. The attempt to determine the reference values for blood biochemical and morphological parameters showed similarities to those of cattle.

Helicobacter pylori infection in patients with haemophilia in Poland: prevalence and risk of upper gastrointestinal bleeding

Infection with Helicobacter pylori is the main aetiological factor for erosive gastritis and duodenal or gastric peptic ulcers often complicated with life-threatening bleeding in patients with coagulation disorders. The aim of this prospective study was to evaluate the prevalence of Helicobacter pylori infection in haemophilia patients, and to assess the risk of gastrointestinal bleeding associated with this infection. From 2000 to 2002, 146 patients with haemophilia (129, haemophilia A; 13, haemophilia B), mean age, 39.9 years (+/-7.3), were investigated for H. pylori infection using IgG and IgA latex serological test. The control group included 100 men with no coagulation disorders, mean age, 40.9 years (+/-9.2). For 72 (49.3%) patients with haemophilia and 39 controls (39.0%) serological tests were positive indicating the presence of H. pylori infection (P =0.1112). A history of gastrointestinal bleeding was reported in 46 patients (31.5%) with haemophilia and in two control group patients (2.0%) (P < 0.0001). Gastrointestinal bleeding was significantly more frequent in patients with haemophilia infected with H. pylori (33/46; 71.7%) than in patients with no H. pylori infection (13/46; 28.3%; P = 0.0002). In conclusion, the prevalence of H. pylori infection in haemophilic patients in Poland is comparable with that in patients with no coagulation disorders. Helicobacter pylori infection is a risk factor for duodenal and gastric ulcer bleeding in haemophilia patients. In view of the high frequency of upper gastrointestinal bleeding associated with H. pylori infection, we believe that screening and eradication therapy are appropriate in haemophilia patients.

Virulence-associated traits in avian Escherichia coli: Comparison between isolates from colibacillosis-affected and clinically healthy layer flocks

Colibacillosis appears to be of increasing importance in layer flocks. The aim of this study was to determine characteristics of avian pathogenic Escherichia coli associated with the occurrence of colibacillosis outbreaks at flock level. Forty E. coli strains originating from layers from healthy flocks ('control isolates'), consisting of 25 caecal and 15 extra-intestinal isolates, were compared with 40 strains isolated from layers originating from colibacillosis-affected flocks ('outbreak isolates'), consisting of 20 caecal and 20 extra-intestinal isolates. The examined characteristics were adhesins, invasivity in T84 cell culture, serum resistance, iron uptake, colicin production, and toxinogenicity. The following traits were significantly more often detected in the outbreak isolates than in the control isolates: tsh, iss, iucA, iutA, irp2, fyuA, iroC, cvaC, colicin and colicin V production. A comparison of the extra-intestinal outbreak isolates and the caecal control isolates yielded the same results as when the caecal isolates, extra-intestinal isolates and total number of isolates of the outbreak and the control group were compared. When comparing the caecal and extra-intestinal isolates within the control and within the outbreak group, no significant differences were detected. The O78 and O2 groups showed significant differences with other O-types and NT strains for prevalence of most of the same characteristics. The combination of type 1 fimbriae, tsh, serum resistance, iss, traT, iucA, fyuA, iroC and colicin or colicin V production was significantly more often present in extra-intestinal outbreak isolates than in extra-intestinal control isolates. Only the combination of serum resistance, fyuA and colicin production was present in all outbreak isolates, with a significantly lower prevalence in the control isolates. None of the characteristics or combinations examined were exclusive to the outbreak isolates.

The effectiveness of long-acting penicillin (penidur) in preventing recurrences of dermatolymphangioadenitis(DLA) and controlling skin, deep tissues, and lymph bacterial flora in patients with "filarial" lymphedema

Dermatolymphangioadenitis (DLA) is a common and serious complication of so-called "filarial" and bacterial non-filarial lymphedema of the limb, affecting skin, lymphatics and lymph nodes. In our previous studies, we demonstrated that more than 60% of patients revealed presence of bacterial isolates in deep tissues, tissue fluid and lymph from the lymphedematous limbs. The question remained open whether elimination or suppression of bacteria dwelling in lymphedematous tissues by administration of low doses of penicillin for long time periods would prevent recurrence of DLA attacks. In this study, we retrospectively evaluated a self/community-selected group of patients with lymphedema of the lower limbs with respect to the efficacy of long-acting penicillin in preventing episodes of DLA. There were no microfilariae or anti-filarial antibodies detected in the investigated group. The questions we asked were: (a) how effective is the benzathine penicillin in preventing recurrences of DLA attacks and (b) how does its long-term administration influence the bacterial spectrum of leg skin, deep tissues, lymph and lymph nodes and sensitivity to antibiotics. Two randomly selected groups of patients, receiving and not receiving penicillin during the same period of time, were compared. Evidently lower recurrence rate of DLA was observed in the treated group (p < 0.002). There was increased prevalence of cocci and gram-positive bacilli with a concomitant decrease of gram-negative bacilli on the foot and calf skin surface. Simultaneously, decreased prevalence of gram-positive cocci and gram-negative bacilli isolates in limb deep tissues and lymph was seen. No resistance to penicillin and other tested antibiotics developed in isolates from the skin surface, deep tissues and lymph. We conclude that long-lasting penicillin is effective in preventing recurrent DLA attacks.

Targeted destruction of normal and cancer cells through lutropin/choriogonadotropin receptors using Hecate-betaCG conjugate

A recent approach to cancer treatment is destruction of malignant and non-malignant tumors by hormonally targeted lytic peptides. The presence of lutropin/choriogonadotropin (LH/CG) receptors has been confirmed in several cancer cells (e.g. breast, ovarian, and prostate). In a series of experiments conducted in vitro, we have used a conjugate of the 23-amino acid lytic peptide Hecate and a 15-amino acid segment of beta-chain of CG. To test the hypothesis that Hecate-betaCG selectively destroys porcine granulosa and luteal cells, and Leydig cancer cell line (BLT-1) possessing LH/CG receptors, the conjugate was added to culture media at different concentrations of 0.5 to 10 micro M. Spleen cells and late passage of granulosa cancer cell line (KK-1) not-possessing LH/CG receptors were used as controls. The toxicity of Hecate-betaCG conjugate was concentration-dependent in all cell types but different among various cells. The toxicity of the conjugate to treated cells was closely correlated with the number of LH/CG receptors per cell. At low concentration (1 micro M), Hecate-betaCG was more cytotoxic to cells bearing LH/CG receptors than to controls (p < 0.01). In contrast to cells possessing LH/CG receptors, cancer cell line KK-1 and spleen cells were sensitive only at concentration of 5 micro M (p < 0.001). We conclude that Hecate-betaCG selectively kills cells expressing LH/CG receptors; its toxicity is dependent on the number of binding sites for LH/CG.

Serum cytokine concentration after liver lobe harvesting for transplantation

OBJECTIVE

To investigate cytokine concentration after liver lobe harvesting for transplantation in order to prove that it is a relatively safe surgical procedure with limited tissue injury.

MATERIAL AND METHODS

Study was performed in 17 healthy liver donors and 6 patients with benign liver tumors. Serum levels of IL-6, IL-1ra and sTNFRI were measured before surgery and on the days 1, 3 and 7 thereafter, by immunoassay (ELISA).

RESULTS

There was a significant increase in serum concentrations of IL-6 on day 1-7 (from 2.4 pg/ml to 315.1 +/- 526, 47.3 +/- 48 and 15.3 +/- 15 pg/ml; p = 0.0002, p = 0.0006, p = 0.003), for IL-1ra on day 1-3 (from 472.5 +/- 436 pg/ml to 2072.6 +/- 3511 and 715.5 +/- 268 pg/ml; p = 0.001, p = 0.004), and for sTNFRI on day 1-3 (from 1075.7 +/- 338.0 pg/ml to 1601.4 +/- 317.0 and 1528.9 +/- 402.0 pg/ml; p = 0.0006, p = 0.003), following liver harvesting. No significant difference was observed between pre and postoperative IL-6 serum concentration, whereas IL-1ra and sTNFRI were elevated only on day 3 after liver resection (p = 0.02, p = 0.04). A significantly higher level of sTNFRI was seen in patients after liver resection, as compared to liver donors on day 1 (p = 0.01), 3 (p = 0.03) and 7 (p = 0.0006) after surgery, whereas on day 3 (p = 0.03) and 7 (p = 0.01) when IL-1ra was measured.

CONCLUSION

The short period of elevated concentrations of IL6, sTNFRI and IL1ra after harvesting of lobes for transplantation and a relatively low serum level of these cytokines indicate that this type of procedure does not evoke any major postoperative SIRS-type reaction as seen not infrequently after resection of liver for primary or secondary liver pathology.

Relationships among ecology, demography and diseases of European bison (Bison bonasus)

The bison population in the Bialowieza Forest in Poland has now grown to approximately 300, while the herds in the Belarusian part of the forest total about 240 bison. The first signs of a health problem in these herds appeared in 1980, when two cases of balanoposthitis were detected in two bulls (2 and 5 years of age). Since 1980 research has been conducted to explain the cause of diseases, particularly balanoposthitis, and to monitor the health of bison in Bialowieza Forest. A total number of 614 bison (294 male and 320 female) of different ages was eliminated between 1980 and 2000. Not all the culled bison were examined (postmortem analysis, histopathological, bacteriological, virological and toxicological examinations, serological tests, molecular research). Based on the increase in numbers, reproduction in this population for the past 21 years is generally considered successful. Among 182 male bison eliminated during 1990-2000, only 85, or 47%, of the animals had balanoposthitis. Thus, the percentage of balanoposthitis cases went from 100% during the 1980s down to 47% in the past decade. It appears that the culling process has been a major factor leading to this decrease. It can be assumed that a set of factors is involved in the appearance of the disease (Corynebacterium spp., Bacillus sp., Pseudomonas aeruginosa, Escherichia coli, Ureoplasma spp, Fusobacterium necrophorum, Streptoccocus spp., Staphyloccocus spp.) while opportunistic infections including nematodes (Onchocerca spp.) are responsible for the occurrence of secondary lesions.

[Dynamic of IL-6 and IL-8 concentrations in patients after surgery treated with total parenteral nutrition]

Exaggerated cytokines productions and development of systemic inflammatory response (SIRS) is the most common cause of postoperative complications and death after major abdominal surgery. The present study was conducted to investigate alterations in systemic production of interleukin-6 (IL-6) and interleukin-8 (IL-8) after total parenteral nutrition (TPN) in surgical patients. Plasma concentrations of IL-6 and IL-8 were measured in 22 patients (10 treated with TPN and 12 without TPN) before major surgery and on the days 1, 3, 7, 10 and 14-16 after, by ELISA test (indications for surgery: stomach, pancreatic and colon carcinoma, complications of IBD and acute pancreatitis). There were no differences between preoperative levels of IL-6 and IL-8 in the examined groups of patients. The highest (on the days 1, 3, 7, 10: 268.3 (p = 0.002), 41.9 (p = 0.03), 122.6 (p = 0.009), 29.3 (p = 0.03) pg/ml respectively) and longer lasting significantly elevated level of IL-6 was observed in the group of patients after major surgery without TPN. In the group of patients received TPN (with glutamine) there was a significantly increased but in comparison with group of patients without TPN, significantly lower level of IL-6 on days 1 and 7 (103.4 and 34.7 pg/ml respectively, p = 0.01). There was no significant change in postoperative concentration of IL-8 after major surgery in the group of patients treated with TPN. The level of IL-8 was significantly elevated (p = 0.01) in the group of patients without TPN on day 1 and 3 following surgery. The IL-8 level in the TPN group vs. group of patients without TPN was significantly lower on day 1 after surgery. After TPN concentration of cholesterol was significantly higher and CRP level significantly lower. We conclude that TPN improved immunological response to major surgical trauma by reduction of the inflammatory response.

Outbreak of vancomycin-resistant Enterococcus faecium of the phenotype VanB in a hospital in Warsaw, Poland: probable transmission of the resistance determinants into an endemic vancomycin-susceptible strain

The first outbreak caused by vancomycin-resistant enterococci of the VanB phenotype in Poland was analyzed. It occurred in a single ward of a Warsaw hospital which is a specialized center for the treatment of hematological disorders. Between July 1999 and February 2000, 11 patients in the ward were found to be infected and/or colonized by Enterococcus faecium that was resistant in vitro to vancomycin and susceptible to teicoplanin. PCR analysis confirmed that the vancomycin-resistant E. faecium (VREM) isolates carried the vanB gene, which is responsible for the VanB phenotype. Pulsed-field gel electrophoresis (PFGE) typing revealed that the isolates belonged to four distinct PFGE types and that one of these was clearly predominant, including isolates collected from seven different patients. The isolates contained one or more copies of the vanB gene cluster of the identical, unique DraI/PagI (BspHI) restriction fragment length polymorphism type, which resided in either the same or different plasmid molecules or chromosomal regions. All this data suggested that the outbreak was due to both clonal spread of a single strain and horizontal transfer of resistance genes among nonrelated strains, which could be mediated by plasmids and/or by vanB gene cluster-containing transposons. The comparative analysis of vancomycin-susceptible E. faecium (VSEM) isolates collected from infections in the same ward at the time of the VREM outbreak has led to identification of a widespread VSEM strain that was possibly related to the major VREM clone. It is very likely that this endemic VSEM strain has acquired vancomycin-resistance determinants and that the acquisition occurred more than once during the outbreak.

Lymph draining from foot joints in rheumatoid arthritis provides insight into local cytokine and chemokine production and transport to lymph nodes

OBJECTIVE

Rheumatoid arthritis (RA) is characterized by inflammatory reactions in joints and adjacent tissues unaccompanied by clinically evident changes in lymphatics and lymph nodes draining the inflamed areas. The explanation for this phenomenon, which contrasts with infectious processes in joints and soft tissues that evoke major changes in the lymphatic system, is unclear. To determine which inflammatory factors produced in the joints of RA patients are transported in lymph to lymph nodes, we measured levels of immunoglobulins, cytokines, and chemokines in prenodal lymph from the foot joints of RA patients and quantified their rate of transport to regional lymph nodes.

METHODS

Lymph was collected from the cannulated lymphatics draining the foot joints, tendons, fascia, and skin of 20 RA patients. Lymph flow rate and concentrations of proteins and immunoglobulins were measured. Cytokine and chemokine levels were quantified by enzyme-linked immunosorbent assays. Results were compared with those obtained in 20 control subjects.

RESULTS

In the cannulated vessel, the mean +/- SEM lymph flow rate in RA patients was almost 2-fold that in control subjects (22.6 +/- 3.2 ml/24 hours versus 13.2 +/- 1.1 ml/24 hours; P < 0.01). Lymph concentrations of total protein, IgG, and IgM were 1.80 +/- 0.14 gm/dl, 384 +/- 45 mg/dl, and 32.0 +/- 1.5 mg/dl, respectively, in RA patients and 1.66 +/- 0.14 gm/dl, 238 +/- 32 mg/dl, and 15.0 +/- 1.3 mg/dl, respectively, in control subjects. The corresponding lymph:serum (L:S) ratios were 0.21 +/- 0.02, 0.22 +/- 0.02, and 0.15 +/- 0.02, respectively, in RA patients and 0.22 +/- 0.02, 0.19 +/- 0.02, and 0.11 +/- 0.02, respectively, in control subjects. The L:S ratios of <1 and the absence of significant differences between groups suggested a lack of local production of immunoglobulins. In RA patients, lymph concentrations (in pg/ml) were as follows: interleukin-1beta (IL-1beta) 14.8 +/- 3.9, IL-6 511 +/- 143, tumor necrosis factor alpha (TNFalpha) 9.9 +/- 1.1, IL-1 receptor antagonist (IL-1Ra) 4,274 +/- 737, IL-10 13.3 +/- 4.4, IL-8 846 +/- 174, IL-15 6.2 +/- 0.9, granulocyte-macrophage colony-stimulating factor (GM-CSF) 2.30 +/- 0.15, vascular endothelial growth factor (VEGF) 80.4 +/- 8.6, and macrophage inflammatory protein 1alpha (MIP-1alpha) 171 +/- 34. In control subjects, these values were as follows: IL-1beta 1.50 +/- 0.25, IL-6 79.0 +/- 14.6, TNFalpha 4.4 +/- 1.1, IL-1Ra 208 +/- 52, IL-10 0.0, IL-8 216 +/- 83, IL-15 5.00 +/- 0.45, GM-CSF 0.40 +/- 0.05, VEGF 42.0 +/- 2.4, and MIP-1alpha 3.4 +/- 1.7 (P < 0.05 versus RA patients for all except IL-15). The L:S ratio was >1 in all RA patient samples for IL-1beta, IL-6, IL-1Ra, IL-8, GM-CSF, IL-10, IL-15, TNFalpha, and MIP-1alpha, indicating local production of cytokines. Great variability in lymph cytokine concentrations, presumably reflecting differences in the intensity of local inflammation, was not reflected in serum cytokine concentrations. Intravenously infused methylprednisolone decreased lymph cytokine levels to normal within 12 hours. In contrast, their concentrations in serum showed little or no change.

CONCLUSION

High lymph concentrations of cyto kines and chemokines, exceeding those in serum, were found in RA patients. The L:S concentration ratios of > 1 indicate the local production of these cytokines and chemokines in the inflamed tissues. High flow rates of lymph containing high cytokine concentrations through the regional lymph nodes are likely to affect node lymphocytes and dendritic cells. Analysis of cytokines in lymph should provide insight into events in inflamed tissues in RA and in regional lymph nodes.

Surgical trauma evokes a rise in the frequency of hematopoietic progenitor cells and cytokine levels in blood circulation

Alterations in the mononuclear cell populations in the blood circulation are among the most characteristic changes after surgical trauma. They reflect changes in the hematopoietic compartment which develop following surgery. The process of mobilization and differentiation of the hematopoietic population is regulated by cytokines known as growth factors for stem and progenitor cells (SCF, IL-1, IL-3, IL-6, IL-1L, TNF, CSFs). Our question was whether operative trauma resulted in the release of the hematopoietic progenitor cells to the blood circulation and an increase in the blood level of cytokines participating in hematopoiesis. The studies were carried out in patients with chronic cholelithiasis, undergoing elective open cholecystectomy under general anesthesia. An increase in the frequency of circulating CD34+ hematopoietic progenitor cells was seen between days 3 and 7 after surgery. Moreover, a significant increase in the percentage of immature cells of myeloid lineage (CD13+, CD14+, CD33+) was seen on the 1st and 3rd postoperative days. This could be the result of an expansion of the total bone marrow cell number after surgery and a subsequent release of these cells into the blood circulation. The changes in blood cell populations were accompanied by an increase in IL-6 on days 1, 3, and 7 following surgery, in IL-6sR on days 10 and 14 and in IL-8 on days 1 and 3. No significant changes in IL-1alpha, IL-1beta, IL-3 and IL-11 were noted. A small rise in GM-CSF was noted in few patients on the 3rd and 7th postoperative days. It is known that IL6 is involved in hematopoiesis, that the IL6-IL-6sR complex may induce both proliferation and differentiation of hematopoietic progenitor cells and that IL8 possesses progenitor cell mobilization properties. The appearance of hematopoietic progenitor cells in the blood following surgery may represent a process for the expansion of the immune cell pool after trauma and maintaining of the reserves at a certain level.

[Value of chosen immunologic parameters in assessment of surgical trauma extent]

The subject of study was to assess the sensitivity of chosen immunological parameters in the extension of the post operative trauma. Two groups of patients were studied: group I--12 patients underwent laparoscopic cholecystectomy (ChL), group II--18 patients underwent conventional cholecystectomy (ChK). We compared changes in the concentration of interleukin 1 receptor antagonist (IL-1ra) and interleukin 6 (IL-6) in blood. Blood tests were taken before operation and 1, 3, 7, 10 days after operation. Levels of IL-1ra and IL-6 were determined by ELISA. It was stated that cholecystectomy (ChK, ChL) evoked statistically significant changes in the value of chosen immunological parameters. In comparison with ChK the ChL evokes significant but smaller and shorter lasting changes in tested parameters of the immunological response that indicates that ChL is less invasive surgical procedure. The IL-1ra and IL-6 concentration changes constitute a very sensitive markers of immunological response to surgical trauma. The value of IL-1ra and IL-6 changes in immunological response monitoring, especially in the patients with postoperative complications requires further investigations.

Bacteriological studies of blood, tissue fluid, lymph and lymph nodes in patients with acute dermatolymphangioadenitis (DLA) in course of 'filarial' lymphedema

Filarial lymphedema is complicated by frequent episodes of dermatolymphangioadenitis (DLA). Severe systemic symptoms during attacks of DLA resemble those of septicemia. The question we asked was whether bacterial isolates can be found in the peripheral blood of patients during the episodes of DLA. Out of 100 patients referred to us with 'filarial' lymphedema 14 displayed acute and five subacute symptoms of DLA. All were on admission blood microfilariae negative but had a positive test in the past. Blood bacterial isolates were found in nine cases, four acute (21%) and five subacute (26%). In 10 acute cases blood cultures were found negative. Six blood isolates belonged to Bacilli, four to Cocci and one was Sarcina. To identify the sites of origin of bacterial dissemination, swabs taken from the calf skin biopsy wounds and tissue fluid, lymph and lymph node specimens were cultured. Swabs from the calf skin biopsy wound contained isolates in nine (47%) cases. They were Bacilli in nine, Cocci in three, Acinetobacter and Erwinia in two cases. Tissue fluid was collected from 10 patients and contained Bacilli in four (40%) and Staphylococci in three (30%). Lymph was drained in four patients and contained isolates in all samples (100%). They were Staphylococcus epidermis, xylosus and aureus, Acinetobacter, Bacillus subtilis and Sarcina. Three lymph nodes were biopsied and contained Staphylococcus chromogenes, xylosus, Enterococcus and Bacillus cereus. In six cases the same phenotypically defined species of bacteria were found in blood and limb tissues or fluids. In the 'control' group of patients with lymphedema without acute or subacute changes all blood cultures were negative. Interestingly, swabs from biopsy wound of these patients contained isolates in 80%, tissue fluid in 68%, lymph in 70% and lymph nodes in 58% of cases. In healthy controls, tissue fluid did not contain bacteria, and lymph isolates were found only in 12% of cases. This study demonstrates that patients with acute episodes of DLA reveal bacteremia in a high percentage of cases. Diversity of blood and tissue bacterial isolates in these patients points to a breakdown of the skin immune barrier in lymphedema and subsequently indiscriminate bacterial colonization of deep tissues and spread to an blood circulation.

Pathways of antigen traffic from skin allotransplant to recipient lymph nodes--an evolutionarily developed route for initiation of rejection of foreign antigens

Immune events developing in the bed of skin allograft and draining lymphatics and lymph nodes are probably a copy of what happens in skin after invasion by bacteria, viruses or fungi. The mechanism of local immune response developed in skin during the evolution and is highly conserved and efficient in elimination of foreign antigens. This is why the take of a skin allograft is so difficult and immunosuppressive measures applied after allogeneic skin transplantation remain so ineffective. Authors present their results of studies on the human skin immune humoral and cellular factors, underlining their specificities and differences compared with blood. They also analyze the role of non-immunological factors, such as tissue fluid formation and lymph flow in transportation of alloantigen to the lymph nodes. The migratory properties of immune cells are an indispensable factor in transfer of alloantigen to the lymph nodes. Understanding of the evolutionarily developed immune events in skin may allow to analyze the process of skin allograft rejection and can give hints for more effective immunosuppressive policy.

Syngeneic and allogeneic blood transfusions produce hematopoietic and immune effects

Blood transfusions (BT) should be considered as transplantation of blood elements. They evoke various alterations in the immune responsiveness of blood recipients, contributing to an increased risk of infection and cancer recurrence. The exact mechanism by which blood transfusions induce a state of reduced immune responsiveness remains unclear. Relatively little is also known about immune changes occurring in lymphoid compartments other than blood following blood transfusions. In the present study, the effect of syngeneic and allogeneic blood transfusions on hemopoiesis and immune responsiveness was examined in a rat model. Transfusions of both syngeneic and allogeneic blood caused an increase in the bone marrow myeloid and lymphoid lineage cell compartments as well as a rise in the percentage of OX7+ stem cells in bone marrow. It was followed by a release of OX7+ stem cells into blood circulation, higher in the case of rats transfused with syngeneic blood. The changes in hemopoiesis were accompanied by a diminished responsiveness of blood, spleen and bone marrow lymphocytes to mitogens in both groups of rats. Data point to early changes in distribution and reactivity of bone marrow and lymphoid cells following blood transfusion.

Blood transfusions downregulate hematopoiesis and subsequently downregulate the immune response

BACKGROUND

Blood transfusions are associated with numerous clinical phenomena attributable to reduced posttransfusion immunocompetency. The exact mechanism by which blood transfusions induce a state of reduced immune responsiveness remains unclear.

STUDY DESIGN AND METHODS

The effect of a large-volume blood transfusion on the frequency and responsiveness of immune cells in lymphoid compartments was examined in normovolemic rats. The effects of syngeneic and allogeneic blood transfusions were compared.

RESULTS

The results in normovolemic rats were compared to those in nontransfused and saline-infused animals. In the normovolemic rats, there was a significant decrease in cells of erythroid lineage in bone marrow, with a slight increase in the percentage of cells in the bone marrow myeloid and lymphoid lineages; a significant increase in the percentage of the OX7+ Thy1+ cell population in bone marrow cells (stem cells are contained in this population) and blood cells; a decrease in the bone marrow OX6+ cell population (HLA class II-positive cells); a decrease in the responsiveness of blood, spleen, lymph node, and bone marrow cell populations to mitogens; and a downregulating effect of both syngeneic and allogeneic blood transfusions on hematopoiesis and cell responsiveness.

CONCLUSION

Massive whole blood transfusion, either syngeneic or allogeneic, constitutes a strong downregulating signal for hematopoiesis, affecting the erythroid, myeloid, and lymphoid cell lineages. It leads also to an attenuation of the responsiveness of hematopoietic tissues to mitogenic stimuli.

[Antibiotic-resistant cystitis in the course of urinary bladder calculi after vesicoureteral reflux operation many years ago]

This is the introduction of chronic cystitis in course of urinary bladder calculi, 12 years after vesicoureteral reflux operation. The nucleus of the calculus (3 x 3 x 4 cm) were unresorbed dexon sutures left after the surgical treatment. Inaccuracy of radiological and ultrasonography examination delayed the settlement of the diagnosis about 18 months, and patient was caused of many months antibacterial therapy. After removal the calculus from the urinary bladder, dysuric disorders abated quickly and than after 8 weeks antibacterial therapy pathological changes in urine analysis disappeared, urine culture was sterile.

Blood cytokine levels rise even after minor surgical trauma

The exact changes in cytokine production and clinical implications of the increased cytokine levels following operative trauma remain unclear. In this study, systemic production of a spectrum of cytokines, including IL1 alpha, IL1 beta, IL6, IL8, IL10, and IFN gamma, was examined in patients undergoing minor elective operative trauma. The levels of IL1 receptor antagonist (ra) and IL6 soluble receptor (sR) were also determined. Although there were no changes in IL1 alpha and IL1 beta plasma levels during the entire observation period, there was a significant rise in IL1 ra level in all patients between postoperative day 1 and postoperative day 14. A significant increase in the IL6 plasma level was seen on days 1, 3, and 7 after surgery and an increase in the IL6 sR level was observed on postoperative days 10 and 14. Interestingly, the IL8 plasma values had risen significantly on days 1 and 3 following the operation. In some patients, an elevation in IL10 plasma level was noted on days 1 and 3 postsurgery. Results demonstrated that even a minor surgical procedure such as cholecystectomy with uneventful wound healing was followed by an appearance in the blood circulation of significant levels of cytokines between day 1 and day 14 after surgery. These observations point to the necessity of searching for methods of down-regulating the systemic cytokine effects after surgical trauma for the routine postoperative management.

[Renal biopsy in the aged]

Pathological findings in urinalysis in the aged persons are usually thought to be caused by pathologic processes other than glomerulopathy. Histological evaluation of renal tissue in older patients is extremely difficult due to coexistence of involuntary changes-hyalinosis, increase in mesangial matrix content, and vascular changes. The aim of the study was to evaluate frequency of glomerulonephritis, both primary and secondary in persons older than 60. In this group, as compared to the younger people the secondary glomerulonephritis was more frequent, amyloidosis and vasculitis nodosa being the most frequent. In primary glomerulonephritis mesangiocapillary type dominate, quite often some tendency to hyalinization could be observed. Renal biopsy is useful as a diagnostic tool in both the aged and young. It should be performed regardless the patients age.

Ribavirin effect on pulmonary function in young infants with respiratory syncytial virus bronchiolitis

To assess the effect of ribavirin on pulmonary function in infants with respiratory syncytial virus bronchiolitis, we performed a randomized (nonmatched), double blinded, placebo-controlled study of 19 infants with RSV bronchiolitis. Infants with underlying respiratory, cardiac or immunologic disease were excluded. Patients were given ribavirin (10) or placebo (9) via an aerosol generator for 18 hours/day for 3 days. Pulmonary function (dynamic compliance, total lung resistance) was calculated using a pneumotachographic method on Days 1, 2 and 7. Differences between groups on clinical criteria were not found. Approximately one-half of each group showed increased compliance and decreased lung resistance after 24 to 48 hours of therapy. By Day 7 compliance had increased 30% in the placebo group and 210% in the ribavirin-treated infants (P = 0.05). Significant differences in the rate of change of lung resistance were not seen by Day 7. We conclude that previously noted improvements in the early course of respiratory syncytial virus bronchiolitis treated with ribavirin do not appear to be a result of measurable changes in pulmonary function. However, paradoxical increases in airway resistance were not found in patients treated with ribavirin.

Vitamin A levels in children with measles in Long Beach, California

Studies from Africa suggest that vitamin A supplementation may reduce morbidity and mortality rates associated with measles among poorly nourished children. We studied 20 children with measles in Long Beach, Calif., and found that 50% (95% confidence interval; 28% to 72%) were vitamin A deficient. This frequency among presumably well nourished American children supports evaluation of vitamin A status as a part of acute management of measles in the United States.

Cefepime. Pharmacokinetics and clinical response in patients with cystic fibrosis

OBJECTIVE

To measure first-dose and steady-state plasma, urine, and sputum concentrations of cefepime and make preliminary assessments of the clinical efficacy of cefepime in patients with cystic fibrosis.

DESIGN

Open noncomparative clinical trial.

SETTING

Memorial Miller Children's Hospital of Long Beach, Calif.

PARTICIPANTS

Twelve patients, aged 4 to 41 years, with a confirmed diagnosis of cystic fibrosis and chronic bronchopulmonary infections.

INTERVENTIONS

Patients received cefepime at 50 mg/kg per dose (maximum dose, 2 g per dose) given intravenously every 8 hours. Clinical evaluations, pulmonary function tests, quantitative sputum cultures, and sensitivity testing were performed before, at the end of, and 2 weeks after therapy.

MEASUREMENTS AND MAIN RESULTS

Mean (+/- SD) peak plasma concentrations after the first dose were 148.2 (36.6) mg/L; the following other values were included: half-life, 1.59 (0.46) hours; area under the curve, 292 (94) microgram/h per milliliter; total-body clearance, 3.01 (1.46) mL/min per kilogram; volume of distribution at steady state, 0.32 (0.10) L/kg; and percent of dose recovered in urine, 52% (27%). Steady-state and first-dose values were similar. Trough levels varied from 6.4 to 7.2 mg/L. Mean (+/- SD) sputum concentrations at steady state varied from 6.3 (5.4) to 4.8 (2.3) mg/L. At completion of therapy, nine of 10 patients' conditions were improved as indicated by clinical scores (greater than 10 points), forced vital capacity (greater than 10%), and a greater than or equal to 1 log decrease in sputum bacterial concentration. Cefepime was well tolerated in 10 patients, but rash and light-headedness developed in two patients. Pseudomonas aeruginosa minimum inhibitory concentration90 increased from the start (64 mg/L) to the end of therapy (256 mg/L) and was unchanged 2 weeks later.

CONCLUSION

Based on these data and the potential advantage of a single agent for the treatment of mixed infections (Staphylococcus aureus and P aeruginosa), comparative clinical trials of cefepime and standard therapy for bronchopulmonary exacerbations in patients with cystic fibrosis appear to be warranted.