Septic separation of the symphysis pubis

Summary Symphysial osteomyelitis has been distinguished from osteitis pubis because of the more serious nature of the disease. We report a case in which there was a pelvic separation similar to that seen after trauma or pregnancy. The previously undescribed complications of bladder perforation and pelvic instability are also noted. There was no predisposing cause in this case, in contrast to the 40 previously reported. The causative organism was staphylococcus aureus, but pseudomonas aeruginosa and escherichia coli have also been found in other cases.

---

Résume L'ostéomyélite de la symphyse pubienne a pu être distinguée de l'ostéite pubienne en raison de sa plus grande gravité. Nous en rapportons un cas dans lequel existait une disjonction symphysaire semblable à celles que l'on observe après traumatisme ou grossesse. On a également noté des complications jamais décrites, à savoir une perforation vésicale et une instabilité pelvienne. Il n'y avait pas de cause prédisposante dans ce cas, contrairement aux 40 observations précédemment rapportées dans la littérature. La bactérie causale était un staphylocoque doré, mais le pyocyanique et le colibacille ont également été retrouvés dans d'autres cas.

     

Pharmacokinetics of tacrolimus (FK 506) in children and adolescents with renal transplants

Background: Only few data exist on pharmacokinetics of tacrolimus in children. Patients: In 1995 and 1996, 14 children (mean age 13 years, range 5-23 years) received tacrolimus after renal transplantation; 10 of these after biopsy-proven steroid-resistant rejection (2 with vascular rejection), two for cyclosporin A (CsA)-induced severe nephrotoxicity, one for untreatable gingival hyperplasia on CsA, and one child was treated primarily after transplantation because of severe liver involvement in nephronophthisis. Pharmacokinetic investigations were performed after establishing a stable maintenance dose with trough levels in the desired window of 5-12 ng/ml. Results: Mean follow-up time was 6 months (range 3-25 months). Eleven patients were still on tacrolimus. Two were discontinued because of severe aggravation of chronic persistent hepatitis C (one of them also developed diabetes mellitus),and one patient was subsequently switched to conventional immunosuppression because of tacrolimus-associated nephrotoxicity. All tacrolimus levels were measured by a modified assay (MEIA, Tacrolimus, Abbott) with improved sensitivity. At the time of switch, median serum creatinine was 234±82 7mgr;mol;l and 6 months after switch 201±99 &mgr;mol/l. All grafts are still functioning. Mean FK-506 dose was 0.16 mg/kg body weight/day (range 0.036-0.30 mg/kg). Mean trough level was 7.1±2.6 ng/ml in the morning and 6.5±2.0 ng/ml in the evening. Median time of maximum concentration (tmax) was 120 min after application, and the mean maximum concentration (Cmax) was 15.2±6.7 ng/ml. Mean area under the curve (AUC) was 104±33 ng * h/ml, with a range from 65 to 169 ng * h/ml. No patient had unsatisfactorily low trough levels during the study. There was only a weak but significant (P<0.05) correlation between dose per kg body weight and AUC and, as expected, an excellent correlation (r²=0.73, P<0.001) between AUC and trough level. Conclusion: Because of interindividual variation between patients, therapeutic drug monitoring of tacrolimus is mandatory. In this study, a daily dose of 0.15 mg/kg was sufficient in most patients. We recommend the performance of at least one pharmacokinetic study after establishing stable FK 506 trough levels to ascertain a safe profile.     

Effect of illuminated nifedipine, a potent antioxidant, on intestinal and vascular smooth muscles.

1. The effects of nifedipine (Nif) and its illuminated nitroso product nitrosopine (NTP) were investigated on lipid peroxidation, KCl elevated smooth muscle tension, and ionic currents of single smooth muscle cells. 2. Illumination of Nif at 400-700 nm within 24-48 h changed it completely to a potent antioxidant, NTP. 3. Nif relaxed the KCl-induced contractions of guinea-pig taenia caeci and rat aorta and reduced the amplitude of the evoked inward Ca2+ current of taenia caeci cells in a concentration-dependent manner. NTP (up to 100 microM) was ineffective in this respect. Pretreatment by NTP (10 microM) did not affect the actions of Nif. 4. The evidence suggests that NTP, generated by day-light illumination from Nif, exerts antioxidant activity but is devoid of voltage-dependent Ca2+ channel (VDC) blocking property and does not interfere with the action of Nif on the smooth muscle cell membrane VDC.     

Perflubron Emulsion in Prolonged Hemorrhagic Shock: Influence on Hepatocellular Energy Metabolism and Oxygen-dependent Gene Expression

Background: Liver dysfunction as a result of impaired oxygen availability frequently occurs following hemorrhage and contributes to delayed mortality. Artificial oxygen carriers may improve oxygen supply to vital organs while avoiding the need for allogeneic transfusion.

Methods: Rats were subjected to hemorrhagic hypotension (mean arterial pressure = 35-40 mmHg for 120 min) and were subsequently resuscitated with (1) stored whole rat blood, (2) pentastarch, or (3) pentastarch combined with perflubron emulsion (PFE; 2.7 or 5.4 g/kg body weight), a second-generation artificial oxygen carrier. Recovery of liver adenosine triphosphate, hepatocellular injury, and expression of glutamine synthetase 1, a gene that is induced by exposure of hepatocytes to low partial pressure of oxygen, were studied at 4 h of resuscitation.

Results: Stored whole blood or pentastarch failed to restore liver adenosine triphosphate concentrations after prolonged shock as compared to sham controls and resulted in increased gene expression of glutamine synthetase 1. Addition of 2.7 g PFE/kg restored liver adenosine triphosphate to control, whereas 5.4 g PFE/kg resulted in adenosine triphosphate concentrations significantly above control. Improved hepatocellular oxygen supply was also confirmed by restoration of the physiologic expression pattern of glutamine synthetase 1. Serum enzyme concentrations were highest after resuscitation with stored blood, whereas addition of PFE failed to further decrease enzyme concentrations as compared to pentastarch alone.     

Experimental induction of embryo-derived teratomas and teratocarcinomas in mice

The present study deals with the induction of teratomas and teratocarcinomas in two strains of mice (C3H/Bln and 129/terSv). 6 to 7 days old egg cylinders were transplanted beneath the kidney capsule of adult syngeneic male and female recipients. Out of 115 grafted embryos 32 gave rise to teratoid tumors. Both the overall tumor incidence (teratomas and teratocarcinomas) and the overall percentage of teratocarcinomas were approximately the same in the strains used. In strain C3H/Bln the gender of the recipient seemed to influence the outgrowth of malignant tumors. Two transplantable C3H-teratocarcinomas could be established (DTC-4, DTC-8). Up to date both have retained their pluripotent differentiation pattern which makes them useful for intended further investigations.     

Morbidität nach Herztransplantation

The morbidity in the long-term course following heart transplantation in childhood is mainly determined by the morbidity of the transplanted graft, by side effects caused by immunosuppression and by psychosocial morbidity due to the special situation of life and growing up with a transplanted heart. Transplant vasculopathy as a specific disease of the transplanted organ itself, is a common complication following heart transplantation and is an important factor of morbidity and mortality, considerably limiting the long-term prognosis. Progressive disturbance of renal function and cumulative incidence of malignant tumors is a further factor limiting prognosis caused by the side effects of immunosuppression.