Predicting surgical infection before the operation

To date, simple skin testing using recall antigens has proven to be the most accurate method of assessing preoperative risk for serious infectious complications. When used in conjunction with measures to control the microorganisms and the environment, evaluation of host defense mechanisms with skin testing can aid in reducing postoperative infectious morbidity and mortality. There are 3 possible therapeutic approaches to anergic patients. Surgery and specific nonsurgical treatments (restoration of blood volume, red cell mass, antibiotics), total parenteral nutrition, and immunorestoration. The challenge for the future is to develop the criteria that will indicate the most important defects which account for the anergic state in individual patients.     

Lymphocyte function in anergic patients.

The lymphocyte function of anergic surgical patients who are at increased risk for sepsis and mortality was studied. In vitro lymphocyte responses appear to be normal in most instances, in that over 80% of patients showed a normal response in a standardized mixed leucocyte culture reaction. Similarly, 56% of the lymphocytes from anergic patients showed a positive in vitro proliferative response with PPD. The ability of in vitro-activated lymphocytes to elicit a skin reaction was determined by culturing the cells of anergic patients with PPD and then reinjecting the lymphocytes or their supernatants intradermally into the original donor. When there was a positive proliferative response to PPD in vitro, the reinjected cells or supernatant elicited a positive skin reaction in 79% of the anergic patients. In contrast, a skin reaction was obtained in less than 20% of the instances when there was no in vitro proliferation to PPD or when the cells were cultured without antigen. These results suggest that one of the acquired immune defects in these anergic patients is an in vivo block of lymphocyte activation.     

Solid-phase immunoglobulins IgG and IgM activate macrophages with solid-phase IgM acting via a novel scavenger receptor a pathway

IgG may accelerate atherosclerosis via ligation of proinflammatory Fcγ receptors; however, IgM is unable to ligate FcγR and is often considered vasculoprotective. IgM aggravates ischemia-reperfusion injury, and solid-phase deposits of pure IgM, as seen with IgM-secreting neoplasms, are well known clinically to provoke vascular inflammation. We therefore examined the molecular mechanisms by which immunoglobulins can aggravate vascular inflammation, such as in atherosclerosis. We compared the ability of fluid- and solid-phase immunoglobulins to activate macrophages. Solid-phase immunoglobulins initiated prothrombotic and proinflammatory functions in human macrophages, including NF-κB p65 activation, H(2)O(2) secretion, macrophage-induced apoptosis, and tissue factor expression. Responses to solid-phase IgG (but not to IgM) were blocked by neutralizing antibodies to CD16 (FcγRIII), consistent with its known role. Macrophages from mice deficient in macrophage scavenger receptor A (SR-A; CD204) had absent IgM binding and no activation by solid-phase IgM. RNA interference-mediated knockdown of SR-A in human macrophages suppressed activation by solid-phase IgM. IgM binding to SR-A was demonstrated by both co-immunoprecipitation studies and the binding of fluorescently labeled IgM to SR-A-transfected cells. Immunoglobulins on solid-phase particles around macrophages were found in human plaques, increased in ruptured plaques compared with stable ones. These observations indicate that solid-phase IgM and IgG can activate macrophages and destabilize vulnerable plaques. Solid-phase IgM activates macrophages via a novel SR-A pathway.     

Three-dimensional craniofacial reconstruction imaging

This review article aims to describe and discuss the imaging techniques most commonly used in medicine and dentistry to obtain three-dimensional images of the craniofacial complex. Three-dimensional imaging techniques provide extensive possibilities for the detailed and precise analysis of the whole craniofacial complex, for virtual (on-screen) simulation and real simulation of orthognathic surgery cases on biomodels before treatment, as well as for the detailed evaluation of the effects of treatment. Laser scanning in combination with the stereolithographic biomodeling seems to be a very promising combination for three-dimensional imaging, although there is still considerable room for improvement. Constant efforts should be made in the direction of developing and enhancing the existing techniques as well as exploring the potential for developing new methods based on emerging sectors of technology.     

Aging and movement errors when lifting and lowering light loads

The purpose was to determine the influence of movement variability and level of muscle activation on the accuracy of targeted movements performed with the index finger by young and older adults. Twelve young (27.4 ± 4.4 years) and 12 older adults (74.5 ± 8.9 years) attempted to match the end position of an index finger movement to a target position when lifting and lowering a light load (10% of the maximum). Visual feedback was provided after each trial. Movement error was calculated as the absolute distance from the target. Movement variability was quantified as the standard deviation of finger acceleration and the variability of end position across trials. The EMG activity of first dorsal interosseus (FDI) and second palmar interosseus (SPI) muscles was measured with intramuscular electrodes. Older adults exhibited greater spatial and temporal errors and greater variability in finger acceleration and end position during both the lifting and lowering tasks. Older adults lifted the load by activating FDI less but SPI the same as young adults, whereas they lowered the load by activating SPI less and FDI the same as young adults. In addition, older adults exhibited lower variability across trials in SPI activation when lifting the load and lower variability for FDI activation when lowering the load. The findings demonstrate that the decrease in spatial and temporal accuracy observed in older adults when lifting and lowering a light load to a target position was due to greater movement variability and differences in antagonistic muscle activity.     

Fertility in female patients with thalassemia

With recent therapeutic advances, thalassemic patients can now reach adulthood and attain reproductive capacity. Endocrine complications due to hemosiderosis and especially hypogonatotropic hypogonadism, which present either with sexual infantilism and primary amenorrhea or with secondary amenorrhea, are common in thalassemic women. The aim of this study was to estimate the frequency of fertility among our female thalassemic patients. Our population included 50 married women with thalassemia major (TM) and 12 with thalassemia intermedia (TI) who are regularly followed in our thalassemic centers. Of the 50 patients with TM, 7 had primary amenorrhea (PA), 9 had secondary amenorrhea (SA), and 34 had normal menstrual function (NM), as did all the patients with TI. Overall we had 62 women who were able to achieve 90 pregnancies and give birth to 87 healthy babies. Most of our patients became pregnant around the age of 25 years. Associated endocrine complications were rare except in the group of patients with PA, as expected. In all patients with PA and SA, the 17 pregnancies were induced (intercourse 10, insemination 3, IVF 4). In the patients with NM and TI, 66 pregnancies were achieved spontaneously and 7 following induction (insemination 3, IVF 4). There were four twin and one triple pregnancies, which all resulted in premature deliveries. Among the seven couples in which both partners had thalassemia major, sperm donation was used in 5 cases, ovum donation in one case, and one pregnancy was achieved spontaneously. These 90 pregnancies resulted in 69 full-term, 12 pre-term, 7 abortions and 2 stillbirths. No severe obstetric complication was observed except for two patients with preeclampsia. One patient with PA who carried the triple pregnancy developed severe cardiac failure, which was successfully treated. Transfusion requirements were increased during pregnancy. Discontinuation of desferrioxamine resulted in elevation of ferritin levels during the second and third trimesters of pregnancy and after delivery. Nine patients who were examined with cardiac echo had a transient increase of ESD and EDD during pregnancy, with return to normal after delivery. Labor was performed by Caesarian section in 26 births (26%) out of the 81 successful pregnancies. These collected data represent the largest number of pregnancies in thalassemic females reported so far and are clearly encouraging for the ultimate improvement of the quality of life in thalassemic patients.