Intestinal transplantation in children

Intestinal transplantation has emerged in the last decade as a lifesaving procedure for patients with intestinal failure who are suffering from complications arising from the administration of total parenteral nutrition. Indications for transplantation include irreversible liver injury and loss of vascular access. At least 50 children in the United States may benefit from intestinal transplantation every year. In this article, indications, pre-and postoperative management, and outcomes of intestinal transplantation in children are discussed.     

THE Editor's Mail

The letter which follows comments on the paper, “The small, frantic voice of the patient,” by Mr. William McPeak, which was published in the January issue of Postgraduate Medicine. A carbon copy of the letter was sent to the Editors, who felt it would be of interest to readers of the Journal and are publishing it with the writer's permission.     

Treatment of murine cryptococcal meningitis with UR-9751 and UR-9746.

In these studies, we compare the efficacy of two new azole antifungals with fluconazole in a murine model of cryptococcal meningitis. Mice were infected intracranially. Beginning one day later, groups of 7-10 mice were treated through to day 10 orally with UR-9751 or UR-9746 at 0.1, 0.25, 0.5, 1 or 10 mg kg(-1) day(-1) or fluconazole at 10 mg kg(-1) day(-1). At 10 mg kg(-1) day(-1), all three drugs prolonged survival over controls, but at 1 mg kg(-1) day(-1) only UR-9746 prolonged survival. Tissue counts were more varied on mice sacrificed 8 days after infection. In general, both UR drugs were equal or more potent than fluconazole, and UR-9751 was more effective than UR-9746.     

Fulminante nichtokklusive mesenteriale Ischämie nach Reperfusion einer hochgradig ischämischen Extremität mit septisch-toxischer Einschwemmung

Nonocclusive mesenteric ischemia (NOMI) is a poorly understood condition marked by progressive intestinal ischemia leading to infarction, sepsis, and death in a high proportion of patients. The mortality rate for this intestinal disorder remains high, even when the diagnosis is made early in the course of the disease. The majority of cases are associated with severe congestive heart failure with low cardiac output, or other illness resulting in dehydration, or the splanchnic vasoconstrictive effect of some medications. Reactive splanchnic vasoconstriction is responsible for nonocclusive ischemic enteritis. This paper presents a case of NOMI after arterial reconstruction of an infected ischemic extremity. A reactive spasm of the superior mesenteric artery in response to a general sepsis after reperfusion of the ischemic tissue was noted in this case. The patient recovered after a few hours following flushing perfusion of mesenteric arteries with alprostadil.     

Antigenic cross-reactivity between Borrelia burgdorferi, Borrelia recurrentis, Treponema pallidum, and Treponema phagedenis

The antigenic cross-reactivity between different Borrelia and Treponema species was determined by the indirect immunofluorescence antibody test and sodium dodecyl sulphate-polyacrylamide gel electrophoresis followed by immunoblotting. The protein profiles of Borrelia burgdorferi, Borrelia recurrentis, Treponema pallidum, and Treponema phagedenis revealed essential differences. Using immunoblotting, rabbit immune sera to B. burgdorferi and B. recurrentis exhibited strong cross-reactivities to heterologous borrelial antigens and, to a lesser extent, to treponemal antigens. Immune sera to T. pallidum and T. phagedenis reacted with heterologous treponemal antigens, but exhibited lesser cross-reactivities to borrelial antigens. Five B. burgdorferi and seven T. pallidum major antigens were not cross-reacting with antisera raised against T. pallidum and B. burgdorferi, respectively. However, absorption of the investigated antisera with a T. phagedenis ultrasonicate eliminated cross-reacting borrelial and treponemal antibodies.