Reconstruction of the external genitals and repair of skin defects of the perineal region using three types of lateral groin flap

Three types of lateral groin flap have been applied to reconstruct the external genitals and to repair skin defects in the perineal region. A single lateral groin flap was used to construct a vagina for 2 patients who had congenital absence of vagina. A composite flap containing iliac crest bone was applied to reconstruct the penis in 11 patients: 8 suffered traumatic amputation and 3 had congenital micropenis. A coaxial pedicle flap of the lateral groin and abdominal area was used to repair skin defects of the penis and scrotum after resection of the elephantiasis caused by recurrent erysipelas in 2 patients, and to relieve postburn scar contracture in the perineal region in another. Using this operative technique, 14 flaps survived completely with satisfactory results; 70% of one composite flap was lost as a result of hematoma. In the single-flap group, the distal portion (3 x 5 cm) of one flap necrosed and was resected and resurfaced with a free skin graft; the final result was good.

Identification of a novel tumor necrosis factor alpha/cachectin from the livers of burned and infected rats

Tumor necrosis factor alpha (TNF-alpha)/cachectin is a monocyte/macrophage-derived cytokine implicated as a proximal mediator of many of the catastrophic host responses to infection or endotoxin. However, circulating levels of TNF-alpha/cachectin have only been episodically detected in hospitalized patients with life-threatening bacterial infections. In the present report, increased quantities of immune-reactive TNF-alpha/cachectin were recovered from the livers of rats 3 days following a lethal burn and infection. Two species of TNF-alpha/cachectin were detected, one of approximately 29 kd and the other 17 kd, as determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. In murine peritoneal macrophages and rat Kupffer cells stimulated in vitro with endotoxin, a 29-kd cell-associated and 17-kd secreted form were also detected. We conclude that the increased appearance in vivo of a 29-kd form of TNF-alpha/cachectin from the livers of lethally burned and infected rats represents a novel cell-associated form of the protein.

A study of the immunofunction in patients of coronary heart disease with the fundamental deficiency and outward excess syndrome

The fundamental deficiency and outward excess syndrome of coronary heart disease can be classified into Qi Yang deficiency with blood stasis (QYD) and Yin deficiency with blood stasis (YD). The patients showed disturbances in immunofunction manifested as marked increase of serum IgG, CIC, IC-IgG and IC-C3 levels and the percentage of B cells in the peripheral blood, while the percentages of OKT3+, OKT4+ and OKT8+ cells markedly decreased, especially the percentage of OKT8+ cells, resulting in an increase of the ratio of T4/8 and imbalance between TS and TH. The authors deem that the fundamental deficiency of coronary heart disease is related to the low cellular immunity, especially the imbalance between TS and TH cells, while outward excess of coronary heart disease is related to hyperactivity of humoral immunity.

Total parenteral nutrition and bowel rest modify the metabolic response to endotoxin in humans

Intestinal mucosal atrophy, as induced by total parenteral nutrition (TPN) and/or prolonged bowel rest, is hypothesized to enhance bowel endotoxin (LPS) translocation and may alter host responses to infection. To examine the effect of TPN-induced bowel atrophy on the response to LPS, 12 healthy volunteers were randomized to receive either enteral feedings (ENT, n = 6) or seven days of TPN without oral intake (TPN, n = 6). Enteral or TPN feedings were terminated 12 hours before the study period when a constant dextrose infusion (50 mg/kg/hour) was initiated and continued throughout the subsequent study period. After placement of arterial, hepatic vein, and femoral vein catheters, metabolic parameters were determined before and for six hours after an intravenous E. coli LPS challenge (20 U/kg). Subsequent peak levels of arterial glucagon (ENT, 189 +/- 39 pg/mL; TPN, 428 +/- 48; p less than 0.01), arterial epinephrine (ENT, 236 +/- 52 pg/mL; TPN, 379 +/- 49; p less than 0.05) and hepatic venous cachectin/tumor necrosis factor (cachectin/TNF) (ENT, 250 +/- 56 pg/mL; TPN, 479 +/- 136; p less than 0.05) were significantly higher in the TPN group than in the ENT group. The extremity efflux of lactate (ENT, -16 +/- 4 micrograms/min-100cc tissue; TPN, -52 +/- 13; t = 2 hours; p less than 0.05) and of amino acids (ENT, -334 +/- 77 nmol/min-100cc tissue; TPN, -884 +/- 58; t = 4 hours; p less than 0.05) were higher in the TPN subjects after the endotoxin challenge. Circulating C-reactive Protein (CRP) levels measured 24 hours postendotoxin were also significantly higher in the TPN subjects (ENT, 1.7 +/- 0.2 mg/dL; TPN, 3.2 +/- 0.3; p less than 0.01). Hence the counter-regulatory hormone and splanchnic cytokine responses to LPS were enhanced after TPN and bowel rest. This is associated with a magnified acute-phase response, peripheral amino acid mobilization, and peripheral lactate production. Thus antecedent TPN may influence the metabolic alterations seen in infection and sepsis via both an exaggerated counter-regulatory hormone response as well as an enhanced systemic and splanchnic production of cytokines.

[Effects of kuo guan powder on immunologic functions in patients with ben-xu biao-shi syndrome in ischemic heart disease]

Ischemic heart disease (IHD) is correlated with the Immunodisturbances. In this study, the immunological effects of Kuo Guan No 1, a powder for aiding Qi and activating the blood, in 17 cases of Qi Yang Xu Xue Yu (QYXXY, ) syndrome, Kuo Guan No 2, powder for nourishing the Yin and activating the blood, in 14 cases of Yin-Xu Xue-Yu (YXXY, ) syndrome had been observed in one month treatment. After treatment with both powder of Kuo Guan No 1 and Kuo Guan No 2, the increased levels of IgG, CIC, IC-IgG and IC-C3 in serum and the numbers of B cells in peripheral blood lymphocyte (PBL) of the patients with Ben-Xu Biao-Shi (BXBS, ) syndrome of IHD angina were markedly decreased and showed no significant difference while compared with the normal controls (P greater than 0.05); the numbers of OKT+3, OKT+4 and OKT+8 cells in PBL, which were lower before treatment in both groups, were obviously increased and showed no marked difference with the controls (P greater than 0.05); the higher ratio of T4/T8 was lowered in group of YXXY syndrome, and showed no difference while compared with the controls (P greater than 0.05), but the ratio in QYXXY syndrome group was lowered than that in the controls (P less than 0.05). After the treatment with Kuo Guan No 1, the increased level of C3 in serum in QYXXY group was lowered down to that of the controls (P greater than 0.05). The results indicated that it is reasonable to consider that "Kuo Guan" powder is an immunoregulative preparation for patients with BXBS syndrome of IHD angina.