Sclerosing encapsulating peritonitis: A case series

Sclerosing encapsulating peritonitis (SEP) is a relatively rare cause of intestinal obstruction characterized by total or partial encapsulation of the small intestine by a thick fibrous membrane and is a difficult preoperative diagnosis. A series of seven cases of SEP is reported. Modalities of preoperative diagnosis along with clinical presentation, operative findings, and histopathology are discussed.     

Serum interleukin-3 levels following autologous or allogeneic bone marrow transplantation: effects of T-cell depletion, blood stem cell infusion, and hematopoietic growth factor treatment

Engraftment of marrow following autologous or allogeneic bone marrow transplantation (BMT) may be influenced by quantity and function of stem cells. T lymphocytes, supporting microenvironmental cells, and hematopoietic growth factors (HGF). To elucidate the physiologic role of interleukin-3 (IL-3) in the engraftment process, serum IL-3 levels were measured in over 400 samples from 77 transplant recipients before and for up to 3 weeks following transplantation using a novel enzyme- linked immunoabsorbent assay (ELISA) with a sensitivity of > or = 78 pg/mL. Thirty-seven patients received two to three log T-cell-depleted allografts. In the remaining 40 patients (18 autologous marrow, 12 allogeneic marrow, and 10 autologous peripheral blood [PB] stem cell), T cells were not depleted (non-TCD) from the grafts. A burst of IL-3 (peak levels, 1,500 to 6,000 pg/mL) was detected in the immediate posttransplant period between day 0 and day 14 in all non-TCD recipients and in 21 of 37 (57%) of TCD recipients. A strong inverse relationship between IL-3 levels and absolute neutrophil count (ANC) was observed in both non-TCD recipients (r = -.796) and in TCD recipients (r = -.897). However, both peak IL-3 levels and mean IL-3 levels from day 0 through 14 were significantly lower in TCD recipients compared with either autologous or unmodified allogeneic marrow recipients (P < .01). The lowest peak or mean day 0 through 14 IL-3 levels were observed in matched related recipients undergoing the most aggressive (2.5 to 3.0 log) T-cell-depleted BMT. Autografted patients receiving blood stem cell transplants alone or posttransplant granulocyte colony-stimulating factor (G-CSF) or granulocyte-macrophage colony stimulating factor (GM-CSF) also had significantly lower peak IL- 3 levels (P < .01). In patients receiving TCD grafts, administration of antithymocyte globulin (ATG) posttransplant significantly increased peak IL-3 levels compared with patients not treated with ATG (P < .04). This study shows that endogenous release of IL-3 is strongly associated with myeloid engraftment and inversely related to ANC. Removal of T lymphocytes from donor marrow or acceleration of engraftment by use of stem cells or growth factors appears to blunt the endogenous release of IL-3 whereas use of ATG posttransplant increases IL-3 release.     

Is the prevalence of pre-eclampsia affected by HIV/AIDS? A retrospective case–control study

Objective

To evaluate the rate of HIV/AIDS (and CD₄ levels) in women with pre-eclampsia compared to that of a control group.

Methods

This was a retrospective case–control study in a tertiary and regional hospital in South Africa. We reviewed the hospital records of women who had delivered in these hospitals between 1 January 2008 and 30 June 2010. The records of women with pre-eclampsia during the study period were analysed. Their HIV infection rate was compared to that of a control group consisting of normotensive healthy pregnant women.

Results

Among 492 cases of pre-eclampsia, 130 (26.4%) were HIV infected. In the control group, 183/500 (36.6%) were HIV infected (p = 0.001, OR = 0.62, 95% CI: 0.47–0.82). After adjustment to match the difference in maternal age and parity, the rate of HIV/AIDS was lower in the pre-eclamptic group than in the control group (p = 0.005, OR = 0.658).

Conclusion

The rate of HIV/AIDS was significantly lower in women with pre-eclampsia than in normotensive healthy pregnant women.     

Kernicterus in an adult who is heterozygous for Crigler-Najjar syndrome and homozygous for Gilbert-type genetic defect

Gilbert syndrome is a common genetic disorder associated with mild unconjugated hyperbilirubinemia and no clinical illness. In contrast, Crigler-Najjar syndrome types I and II are rare genetic disorders associated with severe unconjugated hyperbilirubinemia and a life-long risk of kernicterus. Patients with Gilbert syndrome have low levels of a normal form of uridinediphosphoglucuronate glucuronosyltransferase because of a defect in the promoter region of both alleles, whereas patients with Crigler-Najjar syndrome are homozygous for a defect that yields an abnormal form of the enzyme that has limited or no activity. This case report describes a young adult with Crigler-Najjar syndrome type II in whom kernicterus developed after a laparoscopic cholecystectomy. The development of kernicterus was the result of a largely preventable series of events that lead to an increase in the free fraction of his serum bilirubin. Analysis of his genetic defect showed that he was homozygous for the mutation associated with Gilbert syndrome and heterozygous for a second mutation in the open reading frame of one allele of the bilirubin uridinediphosphoglucuronate glucuronosyltransferase gene. The combined defect leads to severe hyperbilirubinemia and shows how seemingly benign genetic defects, when combined, can cause serious clinical disease. (Gastroenterology 1997 Jun;112(6):2099-103)     

Increased soluble interleukin-1 type II receptor concentrations in postoperative patients and in patients with sepsis syndrome

Plasma interleukin-1 (IL-1) activity is modulated in part through the simultaneous appearance of several inhibitors of IL-1 action, including interleukin-1 receptor antagonist (IL-1ra) and the soluble IL-1 type II receptor (IL-1RII). However, little is known concerning the plasma appearance of these inhibitors in patients following operative trauma or those with sepsis syndrome. In the present report, plasma IL-1beta, IL-1ra, and soluble IL-1RI and IL-1RII concentrations were evaluated in 118 patients with sepsis syndrome or after elective operative trauma. Plasma concentrations of IL-1ra increased significantly following elective operative repair of thoraco-abdominal and abdominal aortic aneurysms, and after bowel resection for inflammatory bowel disease, but did not increase after laparoscopic cholecystectomy. Plasma IL-1ra levels were also elevated in patients with sepsis syndrome. In contrast, soluble IL-1RII levels were only increased in patients after operative repair of thoraco-abdominal aortic aneurysms and in sepsis syndrome, whereas concentrations were unaffected by the other more modest surgical procedures. Plasma IL-1RI concentrations decreased in all postoperative patients in the first 24 hours after surgery. We conclude that both plasma IL-1ra and soluble IL-1RII concentrations often increase in sepsis and following some operative trauma. Less severe operative trauma increases the plasma concentration of only IL- 1ra, whereas both IL-1ra and soluble IL-1RII are increased in patients with sepsis syndrome or following thoraco-abdominal aneurysm repair.     

Simulation of single muscle fibre action potentials

Using the volume conductor model, a single muscle fibre action potential can be expressed as a convolution of the transmembrane current and a weighting function. By simplifying the weighting function, the line source model is derived. We have developed similar expressions to compute the single muscle fibre action potential using simple models and physical considerations without any mathematical complexity. The relationship between the conduction velocity and amplitude is analysed and it is concluded that, for a given fibre, the amplitude is inversely proportional to the conduction velocity. This agrees with the experimental data reported in the literature. The relation between amplitude and fibre diameter is studied. The amplitude increases with diameter owing to the increase in membrane current, but it is counteracted by the increase in conduction velocity. Because of the opposing effects, a point of inflection in the amplitude/diameter relationship is observed. Squareroot, square and linear dependencies of conduction velocity on fibre diameter were used. The difference in the peak-to-peak amplitude with these relationships is small and a linear relation between amplitude and fibre diameter seems reasonable irrespective of the conduction velocity/fibre diameter relationship. The effect of lumping the transmembrane current at the axis of the fibre is discussed. This approximation results in an underestimation of the peak-to-peak amplitude near the surface, and the error is close to 50% for very large fibres. This error is accounted for in the model. The recording distance at which the peak-to-peak amplitude of the signal is 100 μV is found to be 400 μm in the model. This is in good agreement with values obtained from a single-fibre electrode recording. The model is computationally fast and precise. It can easily be used with few modifications to simulate single fibre action potentials recorded using different electrodes.     

A method for determination of muscle fiber diameter using single fiber potential (SFP) analysis

We have used computer simulation to study the relationship between the muscle fiber diameter and parameters: peak-to-peak amplitude and duration of the negative peak of the muscle fiber action potential. We found that the negative peak duration is useful in the determination of fiber diameter via the diameter dependence of conduction velocity. We have shown a direct link between the underlying physiology and the measurements characterizing single fiber potential. Using data from simulations, a graphical tool and an analytical method to estimate the muscle fiber diameter from the recorded action potential has been developed. The ability to quantify the fiber diameter can add significantly to the single fiber electromyography examination. It may help study of muscle fiber diameter variability and thus compliment the muscle biopsy studies.     

Recording and physical characteristics of disposable concentric needle EMG electrodes

There is currently considerable interest in using disposable concentric needle (CN) electrodes for clinical electromyography (EMG). To determine how these electrodes compare with reusable CN electrodes, we have compared signals recorded by these two electrode types from the same muscle in normal subjects. We also made similar recordings with two groups of reusable electrodes. There was no difference in the features of motor unit action potentials (MUAPs) recorded by the two groups of reusable electrodes. Disposable electrodes performed satisfactorily in conventional EMG examination. However, compared to reusable electrodes, the disposable electrodes recorded MUAPs with smaller amplitude and area but with the same area:amplitude ratio and MUAP duration. The physical and electrical properties of the CNE groups were also investigated. Disposable electrodes had lower electrical resistance and greater capacitance than reusable electrodes when measurements were made in saline. Photomicrographs showed that the disposable electrodes had smaller recording surfaces and that the central wire was frequently eccentric in the cannula. The differences in electrical recording characteristics could be due to differences in the size of the recording surface, eccentric placement of the central wire in the cannula or differences in the metal used for the central wire. We conclude that electrical and physical testing may not predict the recording characteristics of needle electrodes. Electrophysiologic testing is necessary to determine how EMG signals recorded by new types of electrodes compare with those recorded by currently used electrodes.     

Modulation of polymorphonuclear leukocyte function by cetiedil

Cetiedil citrate monohydrate inhibits sickling of red cells and aggregation of platelets. We assessed its ability to attenuate polymorphonuclear leukocyte (PMN) function. PMN aggregation in response to 2 X 10(-7) M formyl-met-leu-phe (FMLP) was inhibited in a dose- dependent fashion by cetiedil concentrations ranging from 60 to 250 microM. Additionally, 125 microM cetiedil inhibited PMN aggregation in response to 2 X 10(-7) M FMLP, 20 ng/ml phorbol myristate acetate (PMA), and 1 X 10(-6) M A23187 by 69% +/- 18%, 72% +/- 20%, and 65% +/- 4%, respectively. Inhibition of FMLP-induced aggregation was provided by only 5 min of incubation of the drug with the cells and was partially reversible. Cell viability was unaffected by exposure of PMN to the drug. Correspondingly, 125 microM cetiedil prevented the translocation of calcium from the PMN membrane as assessed by chlorotetracycline fluorescence. Paralleling the effect of the drug on PMN aggregation, 125 microM cetiedil inhibited release of superoxide by 55% and decreased the number of available 3H-FMLP receptors. However, its effect on release of the primary granule constituent, myeloperoxidase, was minimal (4.5% inhibition), while the effect on release of the specific granule product, lactoferrin (27% inhibition), was modest. These studies indicate that cetiedil affects PMN aggregation and superoxide release to a much greater extent than PMN degranulation. Thus, cetiedil may have potential uses in modulating inflammatory response in vivo.     

The natural history of anterior cruciate ligament reconstruction using patellar tendon autograft

The purpose of this study was to review the results of ACL reconstruction using a patellar tendon graft placed ‘over the top’ plus a Macintosh lateral tenodesis, examining changes in knee laxity and functional status with increasing time. There were 74 patients operated on over an 11 year period, and divided into four groups for analysis according to postoperative time. There was a significant and progressive increase in side-to-side laxity difference with time, although functional status did not change significantly, indicating a lack of correlation between objective clinical tests and subjective findings. The highest Lysholm, Tegner and IKDC scores were at 4–5 years after operation, when 60% of patients were at their pre-injury level of sports activity. However, there was always a very significant difference between actual and desired Tegner activity levels for the group as a whole. While there was a significant correlation between degenerative changes and the time between injury and reconstruction, there was no correlation with postoperative time: this provides evidence that ACL reconstruction can protect the knee from later degeneration.