Defective monocyte production of, and T lymphocyte response to, interleukin-1 in the peripheral blood of patients with systemic lupus erythematosus.

Interleukin-1 (IL-1) is a monocyte product with diverse amplifying effects on immune cell reactions. We have studied 16 untreated SLE patients to determine the production of IL-1 by their monocytes under the stimulus of E. Coli lipopolysaccharide (LPS) or phorbol myristate acetate (PMA) and measured by the capacity of their supernatants to augment normal autologous mixed lymphocyte cultures (AMLR) or to replace accessory cells in Con A-induced proliferation of T lymphocytes. Concurrently, we studied the response of T lymphocytes from these same patients to IL-1 by its capacity to increase the percentage of stable E rosette forming cells and by the enhancement of T cell proliferation in AMLR. Monocytes from SLE patients produced significantly less IL-1 activity than those of age matched controls, regardless of the stimulus (LPS or PMA), as well as of the indicator system. All patients with active disease and seven of the 10 patients with inactive disease had decreased production of IL-1 activity as determined by at least one method. Response of T lymphocytes from SLE patients to IL-1 produced by normal monocytes was also found decreased as compared to normals. This defect was more marked in the T cells from patients with active than in those of patients with inactive disease. These findings indicate that the immunoregulatory disturbance that SLE patients have encompasses monocytes as well as T and B lymphocytes and suggest that the defect is either multicentric or originates in the stem cell.     

Lidocaine induces a reversible decrease in alveolar epithelial fluid clearance in rats

BACKGROUND: Lidocaine is widely used in patients with acute cardiac disorders and has also been recently implicated as a possible cause of pulmonary edema after liposuction. The objective of this study was to assess the effect of lidocaine on alveolar fluid clearance, the primary mechanism responsible for the resolution of alveolar edema. METHODS: Alveolar fluid clearance was measured in 29 ventilated rats using our well-validated method over 1 h using a 5% albumin solution instilled into the distal air spaces of the lung. Lidocaine was added to the instilled albumin solution (10(-5) M) or administered intravenously at a dose estimated to achieve a clinically relevant plasma concentration of 10(-5) M. Standard agonists and antagonists were used to determine the effect of lidocaine on alveolar fluid clearance. To determine whether lidocaine acted predominantly on the apical or basal surface, we also used QX314, lidocaine n-ethyl bromide quaternary salt, an analog of lidocaine, which is unable to cross the alveolar epithelium. The effect of lidocaine on the apical epithelial sodium channel transfected in Xenopus oocytes was also studied. RESULTS: Alveolar or intravenous lidocaine decreased alveolar fluid clearance by 50%, an effect that was reversible with the beta2 agonist, terbutaline. Lidocaine acted predominantly on the basal surface of the epithelium because n-ethyl bromide quaternary salt decreased alveolar fluid clearance only when it was given intravenously and because lidocaine did not inhibit the apical epithelial sodium channel when expressed in oocytes. CONCLUSIONS: Lidocaine decreased alveolar fluid clearance by 50%, an effect that may have major clinical implications in the care of patients with cardiac disease or during the perioperative period in some patients. Importantly, the effect of lidocaine was completely reversible with beta2-adrenergic therapy.     

Impact of Cormack and Lehane's grade on Intubating Laryngeal Mask Airway Fastrach using: a study in gynaecological surgery

OBJECTIVE: To evaluate the impact of Cormack and Lehane grade on the Intubating Laryngeal Mask Airway (LMA-Fastrach) using in women. STUDY DESIGN: Open prospective study. PATIENTS: The study included 115 scheduled gynaecologic surgery women. METHODS: An LMA-Fastrach was systematically performed in patients with a Cormack's grade > or =3 or when Arne's score was > or =7 whatever the Cormack. After induction of anaesthesia and neuromuscular blockade, Cormack's grade was assessed and LMA-Fastrach was inserted. Proper insertion was confirmed by the easiness of assisted ventilation and the normal aspect of the capnographic curve. Intubation through the LMA-Fastrach was carried out with the specific kit's endotracheal tube. More than two attempts were considered as a failure of the technique and an alternative method was performed. The following parameters were noted: age, weight, height, clinical predictors for difficult intubation (Arne et al.'s score), number of LMA-Fastrach insertion, ventilation efficiency through LMA-Fastrach, successful intubation with LMA-Fastrach and oesophageal intubation. RESULTS: Ventilation through the LMA-Fastrach was efficient in 97%. The success rate of intubation was 94.8% (86% on the first attempt). The success rate of ventilation and intubation were not statistically different according to the different Cormack's grades. The obesity (BMI>30) did not change the success rate of ventilation and intubation through the LMA-Fastrach. CONCLUSION: In women with either predicted or unpredicted difficult intubation, the success rates of ventilation and intubation through the LMA-Fastrach don't seem to be influenced by Cormack grade and obesity.     

Occupational exposure to styrene: modulation of cytogenetic damage and levels of urinary metabolites of styrene by polymorphisms in genes CYP2E1, EPHX1, GSTM1, GSTT1 and GSTP1

Styrene is widely used in the production of various plastics, synthetic rubber and resins. The aim of this study was to evaluate if individual polymorphisms in xenobiotic metabolizing enzymes, related with the metabolic fate of styrene, could modify individual susceptibility to the possible genotoxic effects of the styrene exposure. Twenty-eight reinforced plastic workers and 28 control subjects were studied. In the selected population the urinary styrene metabolites mandelic (MA) and phenylglyoxylic (PGA) acids were quantified, sister chromatid exchanges (SCE) and micronuclei (MN) were assessed in peripheral lymphocytes and all the subjects were genotyped for GSTM1, GSTT1 (gene deletions), GSTP1 (codon 105 ile==>val), EPHX1 (codons 113 tyr==>his and 139 his==>arg) and CYP2E1 (DraI polymorphism in intron 6). The results obtained showed a significant difference between the levels of SCE, but not in MN levels, in exposed workers as compared with the control group. The GSTP1 and CYP2E1 individual genotypes modulate the baseline levels of SCE that are lower in non-wild type individuals for both polymorphisms. The GSTM1 null individuals with low levels of exposure have significantly higher urinary levels of MA+PGA. The present data seem to suggest that apart from the methodology usually used for monitoring populations occupationally exposed to styrene (urinary metabolites and biomarkers of early biological effects) the analysis of individual genotypes associated with the metabolic fate of styrene should also be carried out in order to evaluate the individual genetic susceptibility of exposed populations.     

Standard preoxygenation vs two techniques in children

BACKGROUND: Preoxygenation is recommended in pediatric anesthesia but it has been poorly assessed. Fractional expired oxygen concentration (F(ET)O(2)) is a preoxygenation monitor. The aim of this prospective study in children was to compare three techniques of preoxygenation by the measurement of F(ET)O(2). METHODS: Twenty children (6-15 years) were included. F(ET)O(2) was measured with the child in a supine position, holding the face mask. The F(ET)O(2) value was measured after 3 min of calm breathing of room air (baseline) and during the three preoxygenation techniques performed in random order: 3 min of tidal volume breathing using an O(2) flow of 9 l x min(-1) (TV x 3 min)--four deep breaths within 30 s using an O(2) flow of 15 l x min(-1) (4 DB)--eight deep breaths within 1 min using an O(2) flow of 15 l x min(-1) (8 DB). Between each technique, at least 5 min breathing room air was allowed to return to baseline F(ET)O(2). Fisher's exact test was used and P < 0.05 was considered significant. RESULTS: Twenty children were studied (age: 11.5 +/- 3 years, weight: 42 +/- 21 kg). The F(ET)O(2) > or = 90% was found to be 79% in 74 +/- 40 s with TV x 3 min, 11% with 4 DB, and 68% with 8 DB. CONCLUSIONS: In children, Vt x 3 min is the most efficient preoxygenation technique to reach F(ET)O(2) > or = 90%.     

Ultrasonographic assessment of inflammatory activity in rheumatoid arthritis: comparison of extended versus reduced joint evaluation

OBJECTIVE: To investigate the validity of reduced joint counts for ultrasonographic (US) assessment of joint inflammatory activity in patients with rheumatoid arthritis (RA). METHODS: Ninety-four patients with RA were included. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels were recorded for each patient. The presence of tenderness, swelling and a subjective swelling score from 0 to 3 were assessed by two rheumatologists who reached consensus in 60 joints examined in each patient. All patients underwent an US examination by a third blinded rheumatologist, using power Doppler (PD). US joint effusion, synovitis and PD signal were graded from 0 to 3 in the 60 joints. A 60-joint count and index for effusion, synovitis and PD signal were recorded. A 6-, 10-, 16-, 18-, and two 12-joint counts and indices for US parameters that included the most frequently US involved joints were calculated for each patient. RESULTS: A 12-joint assessment for effusion, synovitis and PD signal, including bilateral wrist, second and third MCP, second and third PIP of hands and knee joints highly correlated with corresponding 60-joint US counts and indices. This reduced-joint US evaluation showed a similar correlation with clinical and laboratory parameters of disease activity to corresponding 60-joint assessment. CONCLUSION: We propose that a 12-joint evaluation may be a useful tool for US assessment of overall joint inflammatory activity in RA.