Atopy in children and parental social class.

OBJECTIVES: This analysis was conducted to determine whether atopic disorders were related to social class in a pediatric population of a former socialist country. METHODS: A cross-sectional study of 2471 schoolchildren was carried out in 1992 and 1993 in 3 towns in the former East Germany. Parents completed a standardized questionnaire regarding health events and lifestyle factors. In addition, skin-prick tests were performed and total serum immunoglobulin (IgE) was determined. RESULTS: Lifetime prevalence rates for atopic disease and rates of allergic sensitization were highest in children from social class III (in which parents had more than 10 years of formal education) and lowest in social class I (less than 10 years of parental education), while rates in social class II (10 years of parental education) were constant at an intermediate level. CONCLUSIONS: The data confirmed the assumption that in formerly socialist countries social inequalities existed under the socialist system, which were reflected by a social gradient in health outcomes. The findings support the hypothesis that increased access to modern lifestyle could be one reason for the increasing rates of atopic disorders during the last 3 decades.     

Ultrasound assisted liver biopsy for the staging of diffuse chronic hepatopathies

Liver biopsy is the most accurate method for the staging and grading of diffuse hepathopathies. In viral hepatitis staging is required in order to assess firstly if the patient should be treated or not and, secondly, to assess the prognosis. In alcoholic and non-alcoholic steato-hepatitis we only appreciate the prognosis by staging, because the therapy is the same. In this study we analyze the experience of our centre in performing ultrasound-assisted liver biopsies in diffuse chronic hepatopathies. Between 1993-2003 we performed 1460 ultrasound-assisted liver biopsies, all on inpatients, in 93.8% of the cases for the evaluation of viral hepatitis. In the last few years we used sedation with midazolam i.v., the saturation of O(2) being recorded. In the 10 years of the study we encountered one major complication (haemo-peritoneum) (0.07%), treated by conservative methods. The minor complications we encountered, pain and discomfort, were always alleviated by minor analgesics. Vaso-vagal reactions were frequent before we started using midazolam (8.05%), but were no longer present after we performed sedation. None of the liver biopsies was followed by the death of the patient. In 1.37% of the cases we obtained inadequate liver specimens. We performed multiple passages in 0.96% of the cases. In conclusion, ultrasound-assisted liver biopsy is still the "gold standard" of hepatologic evaluation, being a safe and accurate method for staging the diffuse chronic hepatopathies.     

Peg-Interferon Alfa 2a (40kDa) in patients on chronic haemodialysis with chronic C hepatitis. Preliminary results

The aim of the study was to evaluate the response to Pegylated Interferon alpha2a (40 kDa) in patients on chronic haemodialysis with chronic C hepatitis. 10 patients were enrolled in this study (4 males and 6 females). All had increased aminotransferases, anti HCV antibodies and PCR HCV-RNA positive. We administrated Peg-Interferon alpha2a 180 microg/week for 48 weeks. One patient was excluded from the study because of lack of compliance. We had to stop the treatment in one patient due to complications after surgery. After 12 weeks of treatment we evaluated the biochemical and virological response. We continued with Peg-Interferon until 48 weeks. Six patients finished the treatment. After 12 weeks of treatment with Peg-Interferon alpha 2a (40 kDa) in patients on chronic haemodialysis with chronic C hepatitis, the virological response (HCV-RNA absent by PCR) was obtained in 87.5% (7/8) of the cases. All patients who finished the 48 weeks of treatment had normal transaminases (biochemical response) (6/6). We had to reduce the dose of Peg-Interferon in only 2 cases. Even if side-effects occurred in most of the patients (flu-like syndrome, thrombocytopenia or leucopenia) they did not impose the discontinuation of treatment. The sustained response will be established by determining PCR RNA-HCV 6 months after the end of the treatment.     

Room air ventilation for total intravenous general anaesthesia

The use of room air alone to ventilate patients who were anaesthetized with total intravenous anaesthesia, including morphine 2 mg.kg-1, was studied in ten patients. The were scheduled for gastrectomy for peptic ulcer or stomach carcinoma. The patient's minute-ventilation was measured the day previous to surgery; this, together with a frequency of 14 c.min-1, was used to preset the ventilator. Alveolar ventilation, end-expiratory CO2, arterial blood gases and acid-base balance were monitored throughout the procedure. The blood oxygen level was found to remain similar to the reference value; there was a moderate hypocapnia, a low end-expiratory CO2 and minimal changes in acid-base balance. No pulmonary complication was encountered in the postoperative course. These results showed that room air could be used in unusual circumstances for healthy patients for whom a total intravenous anaesthetic technique has been chosen.     

Fluid-electrolyte metabolism and renal function in men under hypokinesia and physical exercise

It has been suggested that hypokinesia (diminished muscular activity) induces significant changes in fluid-electrolyte metabolism and renal function in physically conditioned men. Thus, the aim of this study was to investigate fluid-electrolyte metabolism and ionoregulatory renal function during 16 days of hypokinesia (HK) and 15 days of readaptation period (RP) in 12 physically conditioned male volunteers aged 19–23 years. They were divided into two equal groups. Group 1 was subjected to HK and intensive physical exercise (PE) and group 2 was submitted to pure HK, that is, without the use of any preventive measures. For the simulation of the hypokinetic effect all of the men were kept under a rigorous bed rest regime. Sodium, potassium, calcium and magnesium, creatinine, urea and osmotic concentration were calculated in blood serum and urine samples. Renal excretion of fluid, osmotically active substances and electrolytes was insignificantly different in the two groups. The level and period of water and electrolyte retention were different with respect to the duration of HK. The basic physiological mechanisms of changes in fluid-electrolyte metabolism were consistent with a reduction of the glomerular filtration rate and a change in water and ion transport of renal tubules. It was concluded that HK induced marked changes in fluid-electrolyte metabolism and renal function in physically conditioned men regard-less of their involvement in intensive physical exercise. Experimental studies of hypokinetic physiology are generally based on the assumption that diminished muscular activity (progressive reduction of number of steps per day) is hostile to animal and human organism, since the entire animal kingdom had been formed in a high motor activity environment that left its imprint on the evolution, structure, function and behaviour of animals and man. The impossibility of the body tissues to retain optimum amount of fluid and electrolytes is the dominant hypokinetic effect.     

Human NK cells express Fc receptors for IgA which mediate signal transduction and target cell killing

Receptors for the Fc region of IgG (FcgammaRIIIa, FcgammaRIIc) and IgM (FcmicroR) were previously described on NK cells. In this work the expression of Fc receptors for IgA (FcalphaR) on human NK cells and the signaling events were investigated. The FcalphaR was demonstrated by flow cytometry using secretory IgA (sIgA) and anti-human IgA antibody. The percentage of NK cells (CD3(-)CD56(+)CD16(+)) expressing FcalphaR ranged between 55.7% and 95.7%, with a mean +/- SD of 75.2+/-11.8. The association constant and the number of (125)I-labeled sIgA ((125)I-sIgA) molecules bound per cell, calculated by Scatchard analysis, were 2 x 10(7) M(-1) and 1.7 x 10(4), respectively. The binding specificity was proved by inhibition experiments. Cold sIgA but not IgA Fab fragments were able to inhibit (125)I-sIgA binding in a concentration-dependent manner. Binding of sIgA to NK cells was neither inhibited by anti-mannose receptor antibody, nor by L-fucose, D-galactose, D-glucose, D-mannose or N-acetyl-D-glucosamine. Pretreatment of NK cells with polymeric IgA inhibited their capacity to kill (51)Cr-labeled K562 target cells by 34.8%, whereas with monomeric IgA only by 13.1%. Ligand-induced clustering of the FcalphaR resulted in activation of tyrosine kinases Lck, Syk and phosphatidylinositol 3-kinase. The present studies support the concept that human NK cells bind preferentially sIgA and polymeric IgA with moderate affinity via FcalphaR, which is different from the FcalphaRI/CD89 and other carbohydrate-recognizing receptors like mannose receptor/CD206. This novel structure mediates signal transduction and cell killing.     

Therapy of malignant liver tumors using microwave and radiofrequency ablation

The aim of our study was to evaluate the efficiency for thermo-ablation with microwave and radiofrequency on patients with malignant liver tumors. From January 2002 to January 2005, in our Center of General Surgery and Liver Transplantation in 53 patients 70 sessions of thermoablation were carried out. The mean age was 58 years (25-79 years). Sex ratio men: women was 1.8 (34:19). The diagnosis was hepatocarcinoma in 38 patients (72%), liver metastases from colorectal cancer in 9 (17%) and from non-colorectal cancer (6-11%). The most tumors were single (36-68%). The mean diameter was 39.5 mm (9-94 mm). Percutaneous approach was used in 14 interventions (20%), laparoscopic in 2 (3%) and open approach in 54 cases (77%). We performed 54 sessions of microwave ablation in 42 patients and 8 sessions of radiofrequency ablation in 5 patients. Both methods were applied in 6 patients during 8 sessions. Tumor ablation was done together with liver resection in 10 patients (19%) and resections of other organs in other 8 patients (15%). Morbidity was 12%. The encountered complications were ascites, right pleural effusion and liver abscesses. There was no death. Total and partial necrosis was observed in 27, respectively 20 patients. Local recurrence occurred in one patient but distal liver recurrences were diagnosed in 13 patients. After thermoablation for partial necrosis, local or distal recurrences patients received arterial chemoembolization (5), systemic chemotherapy (23), liver resection (1) and transplantation (1). The mean survival at 1 year and 3 years was 77% and respectively 38%. Microwave or radiofrequency ablation is a simple treatment method, with proved efficiency and minimal risks whose main indication is unresectable tumor.     

A rare indication for liver resection

We present the rare case of a young female with a right upper abdomen tumoral mass and suffering abdominal discomfort. A combination of ultrasonography, computed tomography, magnetic resonance imaging and laparotomy was utilized to conclude a diagnosis of Riedel's lobe. Laparotomy and a resection of Riedel's lobe were selected as the correct therapeutic solutions.