Polymorphonuclear and monocyte functions in measles

The depression of immune responses during measles infection has been recognized since the early 20th century. Acute bacterial infections are the most common cause of morbidity and mortality in measles. This study investigated the phagocytic and bactericidal or fungicidal capacities of polymorphonuclear cells (PMN) and monocytes during measles infections. When 14 children with measles were compared with 25 healthy controls, a significant depression in PMN and monocyte function was found. Of these 14 children, seven developed acute bacterial infections. These seven children were compared with 11 children who had acute bacterial infections without measles. It was found that PMN in patients with measles did not achieve an activated state, as expected with acute infections. Serum immunoglobulins were not altered in these patients. These results confirm previous reports of depressed phagocytic and bactericial capacities of PMN in measles, and further document that peripheral blood monocyte functions are also depressed in measles.     

Fever and neutropenia in children with cancer: diagnostic parameters at presentation

We evaluated 91 episodes of fever in 46 profoundly neutropenic children with cancer, in a search for any symptom, sign or laboratory test that would serve to identify patients with septicemia and differentiate them from those in no immediate need of prompt antimicrobial therapy. Seventeen episodes (19%) were bacteremias, 59 (64%) were suspected septic infections, 9 (10%) were focal bacterial infections and 6 (7%) proved not to be bacterial infections. We were unable to detect any parameter, either on admission or after two days of antimicrobial therapy (except for blood culture findings), that would be helpful in differentiating bacteremia from an episode not of bacterial origin. We focused on serum levels of C reactive protein and found them unreliable on an individual level. Prompt institution of antimicrobial therapy at the occurrence of fever results in low mortality, but does not allow assignment of cases to different categories.     

The tongue flap in the primary treatment of cleft palate: a report of 19 cases.

The conflict between the need to create an effective levator palati sling on the one hand, and the morbidity of raising oral mucoperiosteal flaps on the other, is highlighted in the treatment of clefts of the bony palate, with a limited review of the existing literature. A method in which an anteriorly based tongue flap is used to cover the raw areas resulting from displacement of the oral mucoperiosteal flaps to reconstruct and maintain the levator palati sling in its proper place is described in the primary treatment of cleft palates in 19 cases. One of these cases is presented in detail with the help of illustrations. Comments are added about the method employed. The future plan of action in regard to this method is mentioned.     

The saphenous venous flap

Eight cases, in which a new single-pedicled venous flap, based on the long saphenous vein, was used to close defects around the knee, are presented with the details of indications, size and survival. Of the eight cases, seven achieved their aim; five flaps survived completely, two had partial distal loss and one died completely. This clinical work is further confirmation that fasciocutaneous island flaps of fairly large dimensions, with a single cephalad vein, survive and can be used to cover defects in their adjacent areas.     

Acidosis-induced apoptosis in human and porcine heart

BACKGROUND: Acidosis-mediated injury to cardiac myocytes during surgery may lead to progressive heart failure. The nature of this injury, although not well defined, may be caused by induction of apoptosis in cardiac myocytes. We applied fluorescence imaging and biochemical techniques to assess apoptosis in cardiac myocytes excised from human patients and porcine subjects maintained on cardiopulmonary bypass to demonstrate the relationship between acidosis and apoptosis. METHODS: Multiphoton microscopy was used to image fluorescence signals generated in myocytes deep within atrial and ventricular biopsies for identification of apoptotic changes. The biopsies, obtained during cardiac surgery, were subjected to ex vivo or in vivo acidosis. Proapoptotic markers such as exposure of phosphatidyl serine, cytochrome c, apoptotic protease-activating factor-1, and caspase-3 were identified using fluorescence-based imaging and biochemical assays. RESULTS: Within 30 minutes of storage in low pH (<7) buffers, apoptosis was detected in human atrial samples, the severity of which correlated well with low pH. Apoptosis was also detected in atrial and ventricular biopsy samples obtained from three porcine subjects maintained on cardiopulmonary bypass and undergoing 110 minutes of aortic cross-clamp and 10 minutes of reperfusion, in which the cardiac pH was 6.36, 7.14, and 7.48. The apoptosis level detected in postacidotic reperfused cardiac tissue was pH dependent and approximately threefold greater than the precross-clamp levels. CONCLUSIONS: Using fluorescence multiphoton microscopy and biochemical techniques we have assessed a direct correlation between low pH and induction of apoptosis in cardiac samples obtained both from human patients undergoing cardiac surgery and porcine subjects maintained on cardiopulmonary bypass simulating cardiac surgery.     

A comparison of the tolerability of two dilution volumes (0.5 mL and 1.0 mL) of a purified chick embryo cell rabies vaccine administered intramuscularly to healthy adult volunteers: A randomized, intraindividual, assessor-blind study

Background: The current recommendation of the manufacturer for administering purified chick embryo cell rabies vaccine (PCECV) is to reconstitute the contents with 1.0 mL of water for injection (WFI). However, it has been debated whether a lower volume of WFI (0.5 mL) is likely to cause less pain.Objectives: The aims of this study were to compare the tolerability of PCECV administered IM at a volume of 0.5 mL versus 1.0 mL of diluent and to determine the immunogenicity of the vaccine when administered according to the World Health Organization-recommended preexposure prophylaxis regimen for rabies immunization.Methods: This comparative, intraindividual, assessor-blind study was conducted at the Department of Clinical Pharmacology, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital Mumbai, India). Healthy volunteers aged 18 to 50 years received, by randomized sequence, 3 IM injections of PCECV, diluted in 0.5 mL or 1.0 mL of WFI, on study days 0, 7, and 28. Tolerability was assessed at 30 minutes and 24 hours after injection and included assessments for local and systemic reactions. For immunogenicity assessment, rabies virus-neutralizing antibody 0RVNA) titers were assayed at baseline and on day 49 (ie, 3 weeks after the third injection).Results: Twenty-six subjects (24 men, 2 women; mean [SD] age, 22.4 [2.4] years; mean [SD] body weight, 59.0 [11.3] kg) entered the study. Twenty-five subjects were included in the tolerability assessment; 24 in the immunogenicity assessment. No statistically significant differences were found between dilutions in the frequency of local and systemic reactions. Most reactions were mild. All subjects developed RVNA titers >0.5 IU/mL (indicative of protection) by day 49.Conclusions: In this population of healthy volunteers, a full antigenic dose of PCECV in a dilution of 0.5 mL WFI is as well tolerated locally and systemically as in a dilution of 1.0 mL. All subjects developed levels of RVNA far exceeding 0.5 IU/mL, which is indicative of protection against rabies.