Basophil releasability in severely burned patients.

Thermal injury is known to induce dysregulation of the immune system; however, the precise mechanisms have to be clarified. We investigated the histamine release of basophil granulocytes from severely burned patients (n = 12) after stimulation with anti-IgE or the Ca-ionophore A 23187, respectively. The anti-IgE-induced basophil histamine release of all patients was reduced in comparison to healthy donors beginning at day one postburn (p.b.) (5.0 +/- 2.3% vs. 30.5 +/-3.4%), while the Ca-ionophore-induced release was not decreased before day two p.b. Basophils of patients who finally succumbed to their injuries showed poor responsiveness (to zero levels) over the total time. In contrast, the basophil releasability of surviving patients returned to nearly normal levels (fifth to seventh week p.b.). Already in the second week p.b. there was a significant difference in histamine release between survivors and nonsurvivors [e.g., days 6-9 p.b.: 23.7 +/- 4.0 vs. 6.9 +/- 2.7 (p less than 0.005) after Ca-ionophore stimulation]. The altered basophil histamine release was neither due to a diminished dose- or a delayed time-response to the stimuli nor due to differences in the basophil counts or the cellular histamine content. Our data indicate that the decrease of the basophil releasability, which may be secondary to altered signal transduction pathways in severely burned patients correlates with the clinical outcome.     

Buchbesprechungen

Ohne Zusammenfassung     

Association of glomerular and interstitial mononuclear leukocytes with different forms of glomerulonephritis

Immunophenotyping of mononuclear leukocytes was performed in renal tissue obtained from 69 patients with different forms of glomerulonephritis (GN) and from ten donors' kidneys for transplantation used as controls. A panel of monoclonal antibodies was used in the immunoperoxidase technique on frozen sections to define B- and T-lymphocyte subpopulations, NK cells and monocytes/macrophages, as well as the expression of HLA class II antigens-DQ, -DR and -DP. Quantification of labelled leukocytes revealed a significant increase of CD4+ and CD8+ T-cells in glomeruli of rapidly progressive glomerulonephritis, membranoproliferative glomerulonephritis and even of focal gomerulosclerosis. The number of glomerular monocytes/macrophages was significantly increased only in rapidly progressive glomerulonephritis, whereas in membranoproliferative glomerulonephritis it was decreased. No differences to normal tissue were detected in glomeruli for all other types of inflammatory cells. Interstitial cells were mostly T-lymphocytes in all forms of glomerulonephritis. In all groups the CD4+/CD8+ ratio was somewhat greater than 1 and even about 2 in rapidly progressive glomerulonephritis. Only in particular case was this ratio inversed. High expression of HLA class II antigens was observed on interstitial mononuclear leukocytes, as a sign of their activation. The excess of HLA-DQ-positive cells over the sum of CD14+ and CD20+ cells provides evidence not only for presence of activated T-lymphocytes but perhaps also for accumulation of renal dendritic cells in the interstitium in glomerulonephritis associated with interstitial infiltration.     

Modified full-lid transplants ("tarsomarginal transplants") in reconstructive eyelid surgery

The author first used modified full-thickness lid grafts (tarsomarginal grafts) in lid reconstruction in 1972. They consist of only conjunctiva, tarsus, and lid margin. The anterior lid lamella is rebuilt by a myocutaneous flap from the adjacent tissue. As compared to conventional full-thickness lid grafts, this reduces the risk of necrosis. No cosmetic or functional disturbance of donor eyelids was observed. In cases of total lid loss up to three tarsomarginal grafts can be inserted simultaneously. The use of modified full-thickness grafts is superior to other well-known techniques, especially in cases with defects of the medial half of the lower lid and upper lid defects, up to and including total upper lid loss, even if the tarsus in the grafts is subject to regressive changes and the lashes are usually lost.     

Zulässigkeit der Abgabe von Hilfsmitteln in der Arztpraxis

Abstrakt 1. Die Abgabe von Hilfsmitteln innerhalb einer Arztpraxis ist durch x 4 Nr. 11 UWG (n. F.) i. V. mit x 3 Abs. 2 BO nicht von vornherein ausgeschlossen, wenn dies aus medizinischen Gründen geschieht. 2. Ein etwaiger Versto? gegen sozialversicherungsrechtliche Vorschriften kann nicht als wettbewerbsrechtlich unlauter beurteilt werden; sozialversicherungsrechtliche Normen sind einer wettbewerbsrechtlichen Beurteilung entzogen.     

Reoperations for fractures of the proximal femur

The number and type of reoperations after fractures of the proximal femur was studied in Jokilaakso Regional Hospital, Finland, from 1970 to 1981. Reoperations after fractures of the femoral neck occurred in 32% (24/74), in trochanteric fractures in 13% (6/48). In fractures of the femoral neck 38% (9/24) of the reoperations were performed during the first postoperative year, in trochanteric fractures half of the cases. The average time of hospital stay for reoperation was 19 days.     

Einsatz von Bone-morphogenetic Protein-7 (BMP-7) in der Behandlung von Pseudarthrosen der oberen und unteren Extremität

Bone morphogenetic proteins (BMPs) are bone growth factors, which regulate bone formation during fetal development and bone repair after injury in postfetal life. Since 1992 BMP-7 has been produced by recombinant technique (rhBMP-7). Numerous animal models and clinical trials have shown that rhBMP-7 can induce de novo bone formation in segmental defects of bones and in cases of nonunion. Since 2001 rhBMP-7 has been approved for treatment of tibial nonunion in Europe. The effect of rhBMP-7 is comparable to the clinical and radiological results achieved with bone autografts. The problem of donor site morbidity (which occurs in up to 20% of all cases) is eliminated by the use of BMP-7. Long-term results and experience in clinical practice are not yet available.