Cytokine release by lipopolysaccharide-stimulated whole blood from patients with typhoid fever

The ex vivo cytokine response to lipopolysaccharide (LPS) of whole blood from patients with typhoid fever was investigated. Tumor necrosis factor (TNF)-alpha release by LPS-stimulated blood was found to be lower during acute typhoid fever than after a course of antimicrobial therapy (P相似文献   

Thrombotic microangiopathy and digital necrosis: two unrecognized toxicities of gemcitabine

We report one new case of hemolytic-uremic syndrome (HUS) and one case of digital necrosis after treatment with gemcitabine (Gemzar). Case 1, a 34-year-old man, was given first-line metastatic treatment with gemcitabine for a adenocarcinoma of the pancreas. After a cumulative dose of 10 000 mg/m2 gemcitabine, the onset of subacute renal failure associated with hemolytic anemia of mechanical origin was observed. A diagnosis of probable gemcitabine-induced thrombotic microangiopathy was arrived at. Symptoms resolved after stopping the chemotherapy, in spite of the progression of the disease. Case 2, a 61-year-old man, was administered a combination of gemcitabine and a platinum salt as first-line metastatic treatment for carcinoma of the bladder urothelium. Following a cumulative dose of 10 000 mg/m2 of gemcitabine, the patient suffered from bilateral peripheral vascular disease of somewhat acute onset with hemorrhagic lesions of the finger pads that became necrotic. The work-up was negative and a causal relationship was attributed to gemcitabine. The patient made good progress when given an i.v. infusion of Ilomedine (iloprost trometamol) and chemotherapy was withdrawn. We conclude that gemcitabine must be added to the list of drugs that cause HUS and necrotizing vasculitis.     

Intraocular pressure control and complications with two-stage insertion of the Baerveldt implant

PURPOSE: To evaluate intraocular pressure (IOP) control and the prevalence of complications associated with the two-stage insertion of the Baerveldt implant. DESIGN: Retrospective, noncomparative, interventional case series. METHODS: We reviewed the medical records of all patients who underwent the two-stage Baerveldt implantation for advanced glaucoma between January 1995 and November 1998 at the Doheny Eye Institute, Los Angeles, California. All eyes with a minimum of 6 months of follow-up were included in the study. Eyes that failed before 6 months after stage II were also included in the study. MAIN OUTCOME MEASURES: The criterion for surgical success was postoperative IOP of 6 mmHg or more and 21 mmHg or less on two or more consecutive measurements with or without the use of glaucoma medications and without loss of light perception or further surgical intervention to lower IOP. RESULTS: Nineteen eyes from 19 patients were included. Median postoperative follow-up was 17 months (range, 3-56 months). The cumulative probability of success was 89% at both 12 and 24 months. The median preoperative IOP of 21 mmHg (range, 12-33 mmHg) was reduced to a median postoperative IOP of 12 mmHg (range, 1-17 mmHg; P < 0.0001). The median number of glaucoma medications before surgery was three and after surgery was one (P < 0.0001). Visual acuity remained the same or improved in 13 eyes (68%). One eye experienced hypotony (5%), and in two eyes (11%) suprachoroidal hemorrhages developed. CONCLUSIONS: The two-stage insertion of the Baerveldt implant effectively reduced IOP, produced few complications, and preserved visual acuity in more than two thirds of eyes with advanced glaucomatous damage.     

Malaria co-infection in children influences antibody response to schistosome antigens and inflammatory markers associated with morbidity

The epidemiological coexistence of schistosomiasis and malaria is frequently observed in developing countries. Co-infection with malaria in children could influence the development of acquired immunity associated with the resistance or the pathology of schistosomiasis. In the present study, performed during May to June 1996 in Senegal, the humoral immune response to Schistosoma haematobium 28 kDa glutathione S-transferase (Sh28GST) vaccinal antigen and to soluble egg antigens (SEA) has been evaluated in individuals infected by S. haematobium. Specific immunoglobulin G3 (IgG3) and IgE responses were significantly higher in co-infected children with Plasmodium falciparum compared with children infected with S. haematobium only. In addition, circulating levels of interferon-gamma (IFN-gamma), interleukin-10 (IL-10), and soluble tumor necrosis factor receptor II (sTNF-RII), 3 parameters associated with schistosomiasis morbidity, were significantly increased in co-infected children. Taken together, this study indicated that malaria co-infection can both influence the acquired specific immune response to schistosome antigens and unbalance the regulation of inflammatory factors closely involved in schistosomiasis pathology.     

Change in body water distribution index in infants who become stunted between 4 and 18 months of age

OBJECTIVE: To evaluate body composition changes using bioelectrical impedance analysis and skinfold thickness measurements in infants from tropical areas who become stunted between 4-18 months of age. DESIGN AND MEASUREMENTS: Follow-up study. Extracellular water to total body water ratio index (length(2)/resistance at low to high frequency), peripheral fat (tricipital and subscapular skinfold thickness), and length-for-age index were studied at 4 and 18 months of age. SETTINGS: Low-income areas in four tropical regions (Congo, Senegal, Bolivia and New Caledonia). SUBJECTS: Infants were included in the analysis provided they were neither stunted nor wasted at 4 months. Two groups of infants were compared, those that were stunted at 18 months (n=61) or not (n=170). RESULTS: The extracellular water to total body water ratio index and the sum of skinfold thickness measurements were similar in the two groups at 4 months, and only the extracellular water to total body water ratio index was significantly different at 18 months. When no stunting appeared between 4 and 18 months, the change in the extracellular water to total body water ratio index was not linked with variations in length-for-age, and presented the expected pattern of variation in body water compartments. When stunting occurred, variation in length-for-age was related to significant changes in the extracellular water to total body water ratio index, the biggest increase in the proportion of extracellular water being found in the most stunted infants. Variations in the sum of the two skinfold thickness measurements presented the expected pattern for the 4-18 months growth and did not differ between the two groups. CONCLUSIONS: Multifrequency resistances suggested that stunting was associated with a lack of the expansion of the intracellular compartment that is expected during normal growth of cell mass, together with preserved fat mass. SPONSORSHIPS: Supported by grant 92L0623 from the French Ministry of Research, and by Institut de Recherche pour le Développement (IRD).     

Clinical and imaging anatomy of the scalp

The purpose of this paper is to illustrate the clinical and imaging anatomy of the scalp. The territories of the vessels, lymphatics, and nerves together with the epicranial muscles of the galea are illustrated. The traditional cross-sectional anatomic layers are described and their gross anatomic boundaries are given. They are regrouped into 3 coverings that can be distinguished on normal and pathologic magnetic resonance (MR) and computed tomography (CT) imaging. These are the epidermis/dermis, the subcutaneous layer, and the galea/subgalea/periosteum complex. This information will provide a handy reference to help describe scalp lesions.