Serum immunoglobulin E levels in patients with head and neck cancer

Serum immunoglobulin E levels were estimated in 50 patients with head and neck cancer and in 25 controls. Mean serum IgE value was significantly higher in patients with various sites of cancer in the head and neck region other than carcinoma of the tonsil. The levels increased with advancement in the stage of cancer. There was, however, no difference in mean serum IgE value with respect to the character of the lesion, to the histopathological type of growth or to radiotherapy. In patients with carcinoma of the tonsil, the mean serum IgE concentration was significantly lowered.     

Quantitative and qualitative evaluation of volume of low osmolality contrast medium needed for routine helical abdominal CT

OBJECTIVE: The purpose of our study was to determine the minimum optimal dose of IV contrast medium for helical CT that can preserve image quality while reducing cost. SUBJECTS AND METHODS: Four hundred sixty-three patients from six centers were enrolled in a prospective trial in which patients were randomized into one of four weight-based dose categories of iopromide, 300 mg I/mL: 1.25, 1.50, 1.75, and 2.0 mL/kg. Six of 463 patients were excluded from analysis. A radiologist at each center who was unaware of the volume of contrast medium administered determined whether the scans were acceptable. The responses were analyzed by dose, in aggregate, and by weight. Enhancement values (in Hounsfield units) in regions of interest in the liver, pancreas, aorta, and kidneys were obtained at a single time during the scan. The participating radiologist was unaware of these values. Finally, three additional nonparticipating site observers assessed the images for acceptability, diagnostic quality, and overall level of confidence. A cost model comparing incurred charges in using 150 or 100 mL, or 1.5 mL/kg, of low osmolality contrast medium was developed from experience in an additional 303 patients. RESULTS: We found no clinically significant difference in acceptability of scans at doses greater than 1.5 mL/kg. However, significant variability occurred among the centers. The use of 1.5 mL/kg led to a savings of $9927.16 for 303 patients when compared with the use of 150 mL at list price. The cost is the same for 1.5 mL/kg or use of 100 mL of contrast medium. CONCLUSION: A weight-based dose at 1.5 mL/kg of low osmolality contrast medium can provide acceptable scans in most patients, with a significant cost savings.     

Sequential changes in mucosal immunity after hemorrhagic shock

Immunoinflammatory responses after shock and major trauma are characterized by an early hyperinflammatory response and later by compensatory anti-inflammatory host mediator production. This late phase is associated with depressed immune function that has been causally linked with post-traumatic infectious complications and late organ failure. Gut barrier failure is noted in this setting and may be an important source of nosocomial infections and organ failure. Secretory immunoglobulin A (sIgA) is the predominant immunoglobin at mucosal surfaces and is difficult to quantify in luminal secretions. Attempts to normalize sIgA concentrations may not be accurate and/or may not be applicable in vivo. A method using mucosal immunization with cholera toxin (ChT) to normalize gut sIgA levels was used to assess serial changes in sIgA after hemorrhagic shock (HS) in rodents. Total and anti-ChT sIgA levels were highly variable in both HS and sham animals. However, when normalized using the specific anti-ChT/total sIgA ratio, differences were clearly evident. This ratio was depressed between 3 and 10 days post-HS. The specific anti-ChT/total sIgA ratio is a reliable index of secretory antibody at gut luminal surfaces. Impaired mucosal immune function occurred in a time frame consistent with development of late nosocomial infections. This may be important mechanistically in the development of these infectious complications.     

Ketoacidosis at the diagnosis of type 1 (insulin dependent) diabetes mellitus is related to poor residual beta cell function. Childhood Diabetes in Finland Study Group

The determinants of the degree of metabolic decompensation at the diagnosis of type 1 (insulin dependent) diabetes mellitus (IDDM) and the possible role of diabetic ketoacidosis in the preservation and recovery of residual beta cell function were examined in 745 Finnish children and adolescents. Children younger than 2 years or older than 10 years of age were found to be more susceptible to diabetic ketoacidosis than children between 2 and 10 years of age (< 2 years: 53.3%; 2-10 years: 16.9%; > 10 years: 33.3%). Children from families with poor parental educational level had ketoacidosis more often than those from families with high parental educational level (24.4% v 16.9%). A serum C peptide concentration of 0.10 nmol/l or more was associated with a favourable metabolic situation. Low serum C peptide concentrations, high requirement of exogenous insulin, low prevalence of remission, and high glycated haemoglobin concentrations were observed during the follow up in the group of probands having diabetic ketoacidosis at the diagnosis of IDDM. Thus diabetic ketoacidosis at diagnosis is related to a decreased capacity for beta cell recovery after the clinical manifestation of IDDM in children.     

Standards for total body fat and fat-free mass in infants

Data on body composition in conjunction with reference centiles are helpful in identifying the severity of growth and nutritional disorders in infancy and for evaluating the adequacy of treatment given during this important period of rapid growth. Total body fat (TBF) and fat-free mass (FFM) were estimated from total body electrical conductivity (TBEC) measurements in 423 healthy term Caucasian infants, aged 14-379 days. Cross sectional age, weight, and length related centile standards are presented for TBF and FFM. Centiles were calculated using Altman's method, based on polynomial regression and modelling of the residual variation. The TBF percentage steeply increased during the first half year of life, and slowly declined beyond this age. Various simple TBEC derived anthropometric prediction equations for TBF and FFM are available to be used in conjunction with these standards. Regression equations for the P50 and the residual SD, depending on age, weight, or length, are provided for constructing centile charts and calculating standard deviation scores.