Lymphocyte phenotypes and infection incidence in transfused preterm neonates

The immunomodulating effects of repeated exposure to blood from multiple donors coupled with an immature immune system may predispose the preterm neonate to an increased incidence of infection in his first few months of life. To test this hypothesis, we compared lymphocyte phenotypes, serum IgG concentrations, and histories of infection and rehospitalization in neonates at 4 months corrected age. Two of the study groups were preterm infants who had been transfused with either frozen, deglycerolized or CMV-negative, gamma-irradiated blood. Control groups consisted of nontransfused term and preterm infants. There were no differences found in lymphocyte phenotypes or serum IgG concentrations of controls or transfused infants. No differences were found in the infection or rehospitalization incidence in the transfused infants as compared with nontransfused preterm neonates. We failed to show differences in immune parameters or in infection and rehospitalization rates of the preterm infants analysed. Alongside previously published reports, our data suggest that red cell transfusions have a minimal impact on the immature immune system of the neonate.

Nursing practice related to peritoneal catheter exit site care and infections

OBJECTIVE

The purpose of the study was to obtain information from nephrology nurses on existing policies and protocols related to peritoneal catheter exit site care and treatment of exit site infections.

DESIGN

This was an explorative, descriptive study.

SAMPLE/SETTING

Fifty-four nurses who attended the 1995 Consensus Conference on Peritoneal Dialysis at the 26th Annual American Nephrology Nurses' Association National Symposium completed a survey questionnaire on exit site care and management of exit site infections.

METHODS

A survey was mailed to nephrology nurses preregistered to attend the 1995 ANNA Consensus Conference related to peritoneal dialysis at the 26th National Symposium. Surveys were also collected at the meeting.

RESULTS

Hydrogen peroxide and povidone iodine are frequently used in the nursing care of both healing and chronic exit sites. Almost all of the dialysis units require patients to stabilize or secure the catheter. The majority of respondents had a standardized method of assessing exit sites. Risk factors for exit site infections are presented for both the immediate post-catheter insertion period and the well-healed exit site. There were many different combinations of cleansing agents used to treat inflamed and infected exit sites.

CONCLUSIONS

Procedures for exit site care vary widely. Prospective, randomized studies of exit site care protocols and cleansing agents are necessary to determine the most effective procedures to promote healthy exit sites.

Pediatric and family HIV. Psychosocial concerns across the continuum of disease

In this article, the authors examine the spectrum of HIV disease as it affects parents and their children from the initial diagnosis through the progression of the disease. The psychosocial factors affecting access to health care, family relationships, and issues of loss are focused on. Practitioner guidelines for assisting families to deal with the psychosocial challenges presented by HIV infection are provided.

Personality, stress, coping, and sense of coherence among nephrology nurses in dialysis settings

The goal of this study was to examine the relationships among personality types, personal and work-related stress, coping resources, and sense of coherence (SOC) among nephrology nurses in dialysis settings. Nurses (n = 49) from 13 dialysis units in New Mexico completed a demographic data form, Perceived and Nursing Stress Scales, SOC Scale, Coping Resources Inventory, and the Myers-Briggs Type Indicator (MBTI). The results indicated that there was a positive correlation between perceived personal stress and work-related stress, especially work load. Conversely, there were negative correlations between (a) both personal and work-related stress with SOC, and (b) both coping resources and SOC with burnout. High levels of personal and work-related stress were related to inadequate coping resources. Regression analysis indicated that the main contributing factors to emotional exhaustion (a major component of burnout) were low SOC, lack of staff support, personal stress, and heavy work load. Increased utilization of coping resources may facilitate the nurses' management of personal and work-related stressors.

Quality of life for spouses of CAPD patients

The overall purpose of this study was to describe the quality of life (QoL) for spouses of continuous ambulatory peritoneal dialysis (CAPD) patients and to determine what factors are the best predictors of the spouses' perceived QoL. Thirty-eight spouses of CAPD patients from 2 dialysis units completed a demographic data form, the Jalowiec Coping Scale, the Dyadic Adjustment Scale, and the Quality of Life Index. The primary CAPD nurses completed the End Stage Renal Disease Severity Index on the ill partner. The results showed that 21% of the spouses perceived their QoL as high, 55% perceived their QoL as moderate, and 24% perceived their QoL as fair to poor. The results indicated that the QoL for the spouse is similar to that of CAPD patients with the exception of the family domain. On the family domain, the spouses scored significantly lower. Marital adjustment was the best predictor of QoL for the spouse. Income was the next best predictor. These two variables combined for a predictive value of 85%. Understanding the effect that a chronic illness has on the spouse will assist nurses in providing quality care for both the patient and the spouse.

Plasma proteins and lymphocyte phenotypes in long-term plasma donors

BACKGROUND

The possible effects of long-term plasma donation remain unknown, but it is important to investigate them so that donor safety is ensured. The purpose of this study was to determine if long-term plasma donation alters plasma proteins or lymphocyte phenotypes.

STUDY DESIGN AND METHODS

Two groups of long-term plasma donors, source plasma donors (n = 20) and Rh immune globulin plasma donors (n = 26), were compared with whole blood donors (n = 29) and nondonor controls (n = 30). Blood samples were obtained prior to donation. Serum protein, albumin, globulin, and immunoglobulin levels were determined. In an assay using whole blood, lymphocyte phenotypes were characterized with a panel of single- and dual-labeled monoclonal antibodies and subsequent analysis by flow cytometry.

RESULTS

As compared to the nondonor controls and/or whole blood donors, the mean values for serum protein, globulin, and IgG levels were lower in both plasma donor groups, with a significant negative correlation between donation frequency and serum protein values for the source plasma donors. Albumin levels were within normal ranges for both groups of plasma donors. No significant differences existed among the donor groups in total white cell counts, the percentage or absolute number of lymphocytes, T (CD3) cells, or helper T (CD4) cells. However, there were increased percentages of B (CD19) cells and decreased percentages of suppressor T (CD8+/CD11b+) cells and natural killer cells in both groups of plasma donors as compared to nondonor controls.

CONCLUSION

Many plasma donors have low levels of serum protein, globulin, and IgG. In addition, they have increased percentages of B cells and decreased percentages of suppressor T and natural killer cells. The clinical significance of these findings warrants further investigation.

Lymphocyte phenotypes in infants are altered by separation of blood on density gradients

Flow cytometry techniques for immunophenotyping have revolutionised the diagnosis and monitoring of paediatric immunological disorders. Although recent studies in adult subjects discourage the use of density gradients for cell preparation prior to phenotyping, these procedures continue to be used. The purpose of this study was to determine the effect of density gradient separation on lymphocyte phenotypes from neonates, infants, and adults as compared to whole blood determinations. Subset distributions were different with the two procedures. In all three groups, CD19+ (B cell) and CD8+ (suppressor/cytotoxic T cell) percentages were significantly lower and CD3-CD56+ (NK cell) percentages were significantly higher in the density gradient separated cells. The loss of CD8+ cells in density gradient separation was shown to be a selective event. The CD8+CD11b- (cytotoxic T) subset percentages were lower in the density gradient separated cells, while the percentages of CD8+CD11b+ (suppressor T) cells were not affected by separation procedure. Because of the selective loss of lymphocytes on density gradients, the use of a whole blood technique for immunophenotyping in paediatric subjects is recommended.

Relationship between frequent episodes of peritonitis and altered immune status

A 60-year-old Native American diabetic female patient had a history of nine episodes of peritonitis (both relapsing and persistent) during the year that she was treated with continuous ambulatory peritoneal dialysis (CAPD). At the start of CAPD the patient had an inverted CD4 to CD8 ratio that decreased from 0.97 to 0.50 in 1 year. This finding was due to a decrease in CD4+ cells and an increase in CD8+ cells that were also positive for CD57 (Leu-7) and HLA-DR (Ia) antigen, suggesting a state of activation. The serology indicated a cytomegalovirus immunoglobulin G titer of 1:2,048. The patient also had significantly increased natural killer cells. These alterations suggest the presence of a chronic viral infection that may have caused the patient to be immunosuppressed, thereby predisposing her to repeated episodes of peritonitis.

Work stress, burnout, and sense of coherence among dialysis nurses

The overall goal of this study was to examine the relationship among work stressors, burnout, and sense of coherence (SOC) in dialysis nurses. Two hundred thirty-eight registered nurses from 56 dialysis units completed a demographic data form, the Nursing Stress Scale, the Maslach Burnout Inventory, and Antonovsky's Sense of Coherence Scale. The results indicated that work load was the major contributing factor to both overall stress and burnout. Understanding the stressors that affect responses to the work environment will allow for successful interventions to alter the risk of exhaustion and burnout.

Fever: thermal regulation and alterations in end stage renal disease patients

This article presents an overview of thermoregulatory mechanisms, the pathophysiology of fever, and alterations of the febrile response in end stage renal disease (ESRD) patients. Many ESRD patients do not exhibit the expected rise in white blood cell count or body temperature during clinical and laboratory-confirmed infections. Therefore, leukocytosis and fever cannot be relied on for the diagnosis of bacterial infection in ESRD patients.

Investigation of the effect of long-term whole blood donation on immunologic parameters

Few studies addressing possible immune sequelae of long-term whole blood donation have been published. The purpose of this study was to determine if there were any differences in lymphocyte subsets, monocyte and neutrophil receptors, and antigens important to host defense in committed whole blood donors and in nondonor controls. Blood samples were obtained from 27 whole blood donors who had been donating on a regular basis for at least 4 years and from 21 nondonor controls. A panel of single- and dual-labeled monoclonal antibodies was used to characterize peripheral white cells, and then the cells were analyzed by flow cytometry. Lymphocyte subsets included T (CD3) cells, helper T (CD4) cells, suppressor T (CD8) cells, B (CD19) cells, natural killer (NK) (CD56) cells, and subpopulations of T cells defined by the coexpression of markers for CD3/HLA-DR, CD3/CD56, and CD8/CD11b. Monocyte and neutrophil analysis included quantitation of receptors for C5a, formyl-met-leu-phe, and C3bi (CR3). Monocytes were also analyzed for expression of HLA-DR and CD14 antigens. No significant differences were observed in the whole blood donors and nondonor controls for any of these factors used to assess immunologic status, except for an increase in C3bi receptors on both neutrophils and monocytes from whole blood donors. These findings indicate that the lymphocyte parameters analyzed in this study are unaltered by long-term whole blood donation. Further research is necessary to determine the significance of complement receptor upregulation in whole blood donors and to identify any changes in the functional characteristics of peripheral white cells from whole blood donors.

Prospective comparison of blood and peritoneal lymphocytes from continuous ambulatory peritoneal dialysis patients

Although a few studies have analyzed the characteristics of peritoneal lymphocytes from continuous ambulatory peritoneal dialysis (CAPD) patients, there have been no definitive longitudinal investigations comparing peripheral blood lymphocytes (PBL) with peritoneal lymphocytes (PL) from these patients. Therefore, the purpose of this study was to prospectively compare the phenotypes of PBL and PL of CAPD patients and to determine if phenotypic changes occurred from the initiation of CAPD therapy over the subsequent 12 months. Patients were categorized into younger (< 60 years) or older (> 60 years) to determine if age-related factors contributed to differences in lymphocyte phenotypes. Blood and overnight peritoneal dialysate effluents (PDE) were obtained from 18 patients at the initiation of CAPD therapy and for 11 successive months. Fourteen lymphocyte subsets were quantitated using monoclonal antibodies and flow cytometry analysis. CAPD patients had significantly higher percentages of peripheral activated T (CD3+/HLA-DR+) cells and natural killer (CD57+) cells at the beginning of CAPD than normal controls. There were significantly greater percentages of B cells, activated T cells, and suppressor T (CD8+/CD11b+) cells and significantly fewer helper T (CD4+) cells in the PDE as compared with the patients' peripheral lymphocytes. No significant changes were observed over time in the phenotypes of PBL and only one PL phenotype showed significant changes with fluctuating levels of CD4+/CD45RA+ cells with continued peritoneal dialysis. In general, these findings suggest that although both PBL and PL activation is occurring in clinically uninfected patients, the characteristics of lymphocytes are stable over time.

Pitfalls of bone scintigraphy in suspected hip fractures

In a review of 2617 patients who were admitted with a suspected fractured neck of femur over a period of five years, 213 had normal or equivocal plain radiographs, and were subsequently investigated by bone scintigraphy. Normal scans were obtained in 127 (60%) cases. Of the remaining 86 cases, 82 (38%) were reported to show fractures of the proximal femur, three showed pubic ramus fractures, and one acetabular fracture was demonstrated. Review and follow-up has revealed eight false positive and two false negative scans. The various factors accounting for these errors are considered, and the clinical implications discussed. Careful analysis of accompanying plain radiographs is stressed when interpreting scintigrams.

Recurrent peritonitis: evidence for possible viral etiology

A 45-year-old woman who was treated with continuous ambulatory peritoneal dialysis (CAPD) developed recurrent peritonitis characterized by cloudy effluents, elevated white blood cell (WBC) counts (predominantly lymphocytes), and negative culture results. This case report suggests that she may have had viral peritonitis as indicated by a positive viral culture, the presence of viral antibodies in serum and peritoneal dialysis effluent (PDE), hematological findings, and cell surface receptor studies. The possibility of a viral cause should be considered in patients with culture-negative peritonitis, especially if they do not respond to antibiotics.

Phenotypic characterization of monocytes and macrophages from CAPD patients

The purpose of this study was to phenotypically characterize and compare peripheral blood monocytes from CAPD patients with peritoneal macrophages isolated from their peritoneal dialysis effluents. Monocytes/macrophages were labeled with fluorescent ligands or monoclonal antibodies specific for 1) receptors for C5a, formyl-met-leu-phe (fMLP); Fc region of IgG; C3b (CR1); and C3bi (CR3), 2) Class II histocompatibility antigens HLA-DR and HLA-DQ; and 3) monocyte/macrophage surface antigen CD14. The cells were analyzed using flow cytometry. Results indicated that there were no differences between monocytes and peritoneal macrophages in their receptor expression for fMLP, CR1, or CR3. However, paired t-testing indicated that peritoneal macrophages had significantly increased expression of Fc and C5a receptors, as well as enhanced antigen expression of HLA-DR, HLA-DQ, and CD14. These results suggest that peritoneal macrophages from CAPD patients are activated with increased expression of receptors and antigens important in host defense.

Alteration of host defense mechanisms in chronic dialysis patients

Chronic renal failure patients maintained on dialysis have an increased risk for infection. The mechanisms involved in these patient's increased susceptibility to infection are only partially understood. This article presents a brief overview of normal immune function and summarizes what is known about alterations in immune and phagocytic cell function in chronic dialysis patients.

Comparison of peritoneal white blood cell parameters from continuous ambulatory peritoneal dialysis patients with a high or low incidence of peritonitis

The purpose of this study was to determine if there were differences in selected dialysate white blood cells (WBC) parameters between continuous ambulatory peritoneal dialysis (CAPD) patient groups identified as having a high or low incidence of peritonitis. Parameters studied were total peritoneal WBC yield, percentage and absolute number of various WBC types, and expression of WBC receptors known to be involved in normal host defense mechanisms. WBCs were obtained from peritoneal dialysis effluents (overnight dwell), which were collected at monthly intervals for 6 to 8 months from eight CAPD patients--four with a history of high peritonitis incidence (HPI) (more than two episodes in 12 months) and four with a history of low peritonitis incidence (LPI) (no episodes in more than 24 months). Our results demonstrated that there was no significant difference in the overall mean total cell yields or absolute cell counts between the two patient groups. WBC differentials, although differing somewhat among patients, stayed quite stable over time for an individual patient and there was no significant difference between the two patient groups. Analysis of receptors on the peritoneal WBC was performed using flow cytometry and fluorescein-conjugated chemotactic factors (C5a and fMet-Leu-Phe-Lys), as well as monoclonal antibodies specific for Fc receptors and complement receptors, CR1 (CD35) and CR3 (CD11b). Although there was a trend toward increased expression of all these receptors in the HPI patients, there was no significant difference in the fluorescence intensity of peritoneal neutrophils or macrophages that expressed these receptors between the two patient groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Periodic elevation of complement activation products in peritoneal dialysis effluent

Peripheral white blood cells (WBCs) of chronic ambulatory peritoneal dialysis (CAPD) patients show a reduced expression of chemotactic receptors and a desensitization to chemotactic factor induced events. Chronic complement activation has been suggested as a cause of such phenomena, resulting from either uremia, the indwelling peritoneal catheter, and/or dialysis fluid stimulation. The presence of complement activation products in peritoneal dialysis effluent was assessed by longitudinal measurement of C3bi in eight patients over a 6 to 8 month period, while peritoneal polymorphonuclear leukocyte (PMN) and monocyte CR3 and C5a receptor expression was quantitated by flow cytometry. In six of eight patients, C3bi levels were stable over time and usually measured less than 5 micrograms/ml. Two other patients showed periodic elevation of C3bi, which was not associated temporally with peritonitis. Further study is required to identify the origin of such activated complement components within the peritoneal cavity. However, no correlation was found between dialysate C3bi levels and peritoneal PMN or monocyte expression of CR3 or C5a receptors. Furthermore, the incidence of peritonitis for the two individuals with elevated C3bi was discordant (1 episode/8 patient months vs. 0 episodes/32 patient months), suggesting little or no relationship between these parameters.

Coronal fractures of the lateral femoral condyle

We reviewed seven patients with coronal fractures of the lateral femoral condyle and studied the mechanism of injury and the radiological features. The influence of soft tissue attachments on the displacement and the blood supply were investigated by clinical and cadaveric studies. All three fractures which were initially undisplaced lost position early during conservative management. Internal fixation gave good results at review, and is recommended to avoid the risk of malunion and possible secondary osteoarthritis.

Alterations in chemotactic factor-induced responses of neutrophils and monocytes from chronic dialysis patients

Chronic renal failure patients on dialysis have an increased susceptibility to infection. Previous studies have demonstrated that these patients have a decreased in vitro neutrophil (PMN) chemotactic response and a reduction in C5a receptor availability on both PMN and monocytes. This study was designed to determine if other chemotactic factor-mediated responses of PMN and monocytes from hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients are abnormal. The responses investigated included in vitro chemotaxis, superoxide generation, H2O2 production, and myeloperoxidase (MPO) release. These studies showed that PMN from HD and CAPD patients are significantly decreased in their chemotactic response to both C5a and fMLP when compared to normal controls. The response of HD patient's PMN to C5a was decreased by an average of 55.1% (p less than 0.005) and for CAPD patients by 49.7% (p less than 0.01). Similarly, chemotactic responses to fMLP were decreased by an average of 44.7% (p less than 0.005) for HD patients and 36.3% (p less than 0.02) for CAPD patients. Superoxide anion production by PMN and monocytes from HD and CAPD patients in response to C5a and fMLP was also significantly decreased compared to controls. PMN superoxide production in response to C5a was decreased by an average of 36.5% (p less than 0.001) for HD patients and 32.0% (p less than 0.001) for CAPD patients. fMLP-stimulated production of superoxide was also decreased but to a lesser degree with a mean decrease of 18.0% (p less than 0.01) for HD patients and 24.1% decrease (p less than 0.01) for CAPD patients. This decreased responsiveness was restricted to C5a- and fMLP-stimulated superoxide production since phorbol myristate acetate (PMA)-stimulated responses were comparable to controls. A similar pattern of decreased superoxide production was found with monocytes from these patients. Comparable decreases in chemotactic factor-stimulated responses were also observed in a flow cytometric assay of H2O2 production in both PMN and monocytes and an in vitro assay of MPO release from PMN. Analysis of the binding of fluorescent C5a to PMN showed a direct correlation between decreased C5a binding and decreased O2- production and MPO release. Since all of these chemotactic factor-stimulated events are involved in the inflammatory process and the killing of microorganisms, alterations in these WBC functions in dialysis patients may contribute to their increased susceptibility to infection.

Phenylalanine and tyrosine in serum and eluates from dried blood spots as determined by reversed-phase liquid chromatography

We have developed a reversed-phase liquid-chromatographic procedure for simultaneously determining phenylalanine and tyrosine in serum and eluates of dried blood spots. Batch derivatization with phenylisothiocyanate and a 10-min linear gradient chromatographic assay with ultraviolet absorbance detection provide rapid sample throughput. Interrun precision (CV) is less than 12%; analytical recovery (from blood spot samples) exceeds 85%. Results for patients' samples correlate well with those from an amino acid analyzer and we encountered no apparent interferences. The speed and specificity of this assay facilitate the rapid diagnosis and monitoring of patients with phenylketonuria.

Phenylalanine and tyrosine in serum and eluates from dried blood spots as determined by reversed-phase liquid chromatography

We have developed a reversed-phase liquid-chromatographic procedure for simultaneously determining phenylalanine and tyrosine in serum and eluates of dried blood spots. Batch derivatization with phenylisothiocyanate and a 10-min linear gradient chromatographic assay with ultraviolet absorbance detection provide rapid sample throughput. Interrun precision (CV) is less than 12%; analytical recovery (from blood spot samples) exceeds 85%. Results for patients' samples correlate well with those from an amino acid analyzer and we encountered no apparent interferences. The speed and specificity of this assay facilitate the rapid diagnosis and monitoring of patients with phenylketonuria.

Neutrophil and monocyte alterations in chronic dialysis patients

Chronic renal failure patients maintained on dialysis have an increased risk for infection. This article summarizes research that has been done on the function of neutrophils (PMNs) and monocytes from chronic hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients. The studies involving the HD patients showed that there is a decreased PMN in vitro chemotactic response, decreased C5a receptors on both PMNs and monocytes, and decreased oxidative metabolic responses of PMNs and monocytes to the chemotactic stimuli C5a and formyl-met-leu-phe (fMLP), but not to nonchemotactic factors. The results of studies involving phagocytosis have been conflicting and are discussed in this paper. Due to the basic principles of peritoneal dialysis, this treatment approach depletes the peritoneum of phagocytic cells, adversely affects the function of peritoneal WBCs, dilutes the existing opsonins, and alters the physiologic environment of the peritoneal cavity. Studies of peripheral PMN and monocyte function in CAPD patients have shown that, similar to HD patients, they also have decreased C5a receptors and decreased oxidative metabolic responses to the chemotactic factors C5a and fMLP. Although the factors contributing to the risk of infection in chronic dialysis patients are multifaceted, there are definitely alterations in PMN and monocyte function.

Leukocyte C5a receptor modulation during hemodialysis

Exposure of blood to hemodialysis (HD) membranes results in the activation of the complement system. In this study, flow cytometry was used to analyze the binding of fluoresceinated chemotactic factors (C5a, f-Met-Leu-Phe-Lys [fMLPL], and casein) and aggregated IgG to PMN and monocytes isolated from normal whole blood following passage through a hemodialyzer. Analysis of ligand binding by these PMN and monocytes showed no difference in the binding of casein, fMLPL, or aggregated IgG throughout the 45 minute procedure. In contrast, a progressive decrease in the binding of C5a by PMN and monocytes occurred. By 45 minutes, the average percentage of PMN binding C5a had dropped from 95 to 61% and monocytes from 73 to 40%. In additional studies, blood samples were obtained from chronic renal failure patients undergoing hemodialysis at four different time intervals during dialysis. Total white blood cell (WBC) counts showed that the mean WBC count at 30 minutes dropped to 60.9% of the predialysis WBC count, and rebounded to 133.8% by two hours and 128.2% by four hours. Analysis of the binding of C5a, casein, fMLPL, or aggregated IgG by PMN or monocytes from HD patients indicated there were no significant differences at the four time intervals studied. When blood samples from normal subjects or chronic hemodialysis patients were incubated in vitro with dialysis membrane fibers, a loss of identifiable C5a receptors was observed on PMN from normal blood, while PMN from HD patients showed no significant change in the percentage of C5a-receptor-positive cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of density changes and chemotactic receptors of leukocytes from chronic hemodialysis and peritoneal dialysis patients

Analysis of standard Ficoll-Hypaque (density = 1.077 g/ml) separation profiles of peripheral white blood cells (WBC) from patients undergoing hemodialysis (HD) demonstrated that dialysis caused a marked decrease in the density of polymorphonuclear leukocytes (PMN) resulting in about 50% of these cells separating with the mononuclear cells. In vitro exposure of normal control peripheral blood to HD membranes as well as to the purified chemotactic factors C5a, C5ades-Arg, and formyl-Met-Leu-Phe (fMLP) also resulted in PMN density changes which altered the Ficoll-Hypaque separation profiles of WBC. Therefore, these results imply that C5a generation, resulting from complement activation by the HD membrane, induced the density changes in the PMN from HD patients. Further studies using flow cytometry and fluorescein-labeled chemotactic factors (C5a, formyl-Met-Leu-Phe-Lys [fMLPL] and casein) indicated that HD patients had a significant reduction in the ability of their PMN and monocytes to bind C5a. This contrasted with the findings of no significant difference in the percentage or fluorescence intensity of HD patients' PMN or monocytes binding casein or fMLPL. Functional studies to analyze chemotactic-factor-mediated responses indicated that there was a decreased ability of HD patients' PMN and monocytes to generate superoxide anion, produce H2O2 and release myeloperoxidase in response to both C5a and fMLP. Additional studies evaluated the binding of chemotactic factors to PMN and monocytes from normal blood following passage through a hemodialyzer and from patients undergoing HD. Analysis of receptor binding by control cells passed through the dialyzer showed that there was a progressive decrease in the percentage of C5a-receptor-positive PMN and monocytes but no change with casein or fMLPL. In contrast, peripheral PMN and monocytes from chronic renal failure patients on HD showed no difference in C5a, casein or fMLPL receptors during the course of HD as compared to the predialysis period. This appears to be attributable to a difference in the regulation of the C5a that is generated as a result of the dialysis-membrane-induced activation of the complement system. Although C5a has been shown to be continuously generated during the course of HD, these patients show no modulation of their C5a receptors during the course of HD or when their whole blood is exposed to dialysis membrane fibers. These findings suggest that there are mechanisms functioning in chronically dialyzed patients to protect them from the effects of excessive C5a generation during HD.(ABSTRACT TRUNCATED AT 400 WORDS)

C5a receptor modulation on neutrophils and monocytes from chronic hemodialysis and peritoneal dialysis patients

Chronic renal failure patients have an increased risk for infection which may partially be due to altered chemotactic ability of their white blood cells. This study was designed to evaluate chemotactic factor and Fc receptor expression on neutrophils (PMN) and monocytes from chronic renal failure patients on hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD). Analysis of these receptors was performed using flow cytometry and fluorescent chemotactic factors (C5a, f-Met-Leu-Phe-Lys [fMLPL] and casein) and heat-aggregated human IgG. Peripheral blood PMN and monocytes obtained from 14 HD patients (in the predialysis period) and 14 CAPD patients were analyzed for their ability to bind each of the fluoresceinated ligands. PMN and monocytes from both patient groups had a significant reduction in their ability to bind C5a. The average percentage (+/- s.e.m.) of PMN that bound C5a was 93.9 +/- 1.1 for the controls, 72.9 +/- 3.8 for HD patients, and 79.3 +/- 4.0 for CAPD patients. Similar results were obtained with monocytes with 69.7 +/- 1.9% for controls, 54.6 +/- 4.5% for HD patients, and 31.0 +/- 4.5% for CAPD patients. These differences in C5a binding were also reflected in the average intensity of fluorescence. There was no significant difference in the percentage or fluorescence intensity of PMN or monocytes that bound casein or aggregated IgG when either group of dialysis patients was compared to the control values. Binding of fMLPL by PMN and monocytes from the HD patients and PMN from the CAPD patients were similar to control values but the binding of fMLPL by monocytes from CAPD patients was significantly suppressed (p less than 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Density changes in leukocytes following hemodialysis or exposure to chemotactic factors

Analysis of standard Ficoll-Hypaque separation profiles of peripheral WBC from patients undergoing hemodialysis (HD) demonstrated that dialysis caused a marked alteration in the number of cells found at both the interface between the Ficoll-Hypaque and plasma which normally contains mononuclear cells and the cell pellet which normally contains granulocytes. By 30 min into dialysis, there was a 175% increase in white blood cells in the mononuclear band with a corresponding decrease in the number of cells obtained from the cell pellet. When peripheral blood samples from normal donors were pumped through various types of hemodialyzers, a shift in the cell separation profiles similar to that of patients undergoing HD was observed. Differential analysis of the cells obtained from both the interface between the Ficoll-Hypaque and plasma and the cell pellet showed that by 30 min into dialysis, the 'mononuclear' band contained 40-50% polymorphonuclear neutrophils (PMN). To ascertain whether the cell separation changes were possibly due to C5a generation resulting from complement activation by the HD membrane, whole blood was incubated with the purified chemotactic factors C5a, C5ades arg, and formyl-methionyl-leucyl-phenylalanine. This resulted in similar alterations in PMN densities. This study demonstrates that both in vivo and in vitro exposure of human peripheral blood to HD membranes as well as the chemotactic factors C5a, C5ades arg, and formyl-methionyl-leucyl-phenylalanine results in density changes in PMN.(ABSTRACT TRUNCATED AT 250 WORDS)

Conservative surgery for vesicocolic fistula

Vesicocolic fistula due to diverticular disease of the colon is conventionally treated by resection of the diseased bowel and closure of the vesical defect. Three cases are described in which separation of the viscera and simple suture of the vesical and colonic defects was carried out. A greater omental graft was interposed between the rectum and bladder. Two of the patients are well 12 and 26 months postoperatively. The third patient died a year postoperatively from a complication of her diverticular disease.

Demonstration of specific receptors for fluoresceinated casein on human neutrophils and monocytes using flow cytometry

Casein is chemotactic for human neutrophils (PMNs) and monocytes. The binding of fluorescein (FITC)-conjugated casein (mixture of alpha, beta, and kappa-casein) and purified alpha-casein to PMNs, monocytes, and lymphocytes was analyzed using flow cytometry. These studies demonstrate that 75-95% of PMNs and 46-85% of monocytes have membrane receptors for casein while lymphocytes lack these receptors. The binding of FITC-casein and FITC-alpha-casein was specific and was blocked only by unlabeled casein and alpha-casein, but not by ovalbumin, bovine or human serum albumin, beta-casomorphin, C5a, or formyl-methionyl-leucylphenylalanine (fMLP). The binding of FITC-casein was reversible when PMNs were stained with this fluorescent agent and subsequently incubated with unlabeled casein. Double-labeling studies of mononuclear cells using FITC-casein and the OKM1 monoclonal antibody in conjunction with a rhodamine conjugated anti-Ig second antibody demonstrate that mononuclear cells binding FITC-casein also stain with the OKM1 monoclonal antibody, indicating a specificity for monocytes.

Contribution of noradrenergic and serotonergic neurons to the circulatory effects of centrally acting clonidine and alpha-methyldopa in rabbits

The effects of intracisternal clonidine (0.04, 0.2, and 1.0 microgram/kg) and of alpha-methyldopa (alpha-MD; 400 micrograms/kg) on mean arterial pressure (MAP) and heart rate (HR) were studied in conscious rabbits before, and 7 and 14 days after, intracisternal injection of (a) vehicle, (b) 6-hydroxydopamine (6-OHDA; 600 micrograms/kg), or (c) 5,6-dihydroxytryptamine (5,6-DHT; 633 micrograms/kg) (n = 6 per group). In the initial control experiment clonidine and alpha-MD produced similar falls in MAP and HR in each group; there was also good reproducibility of responses in vehicle-treated rabbits on the 3 experimental days. But after 6-OHDA or 5,6-DHT administration the circulatory effects of clonidine and alpha-MD were markedly attenuated. On day 14 after injection of 6-OHDA, the clonidine-induced falls in MAP and HR averaged 38 and 18%, respectively, of the control responses (p less than 0.001). On day 14 after 5,6-DHT administration, the falls in MAP and HR after clonidine administration were reduced to 27 and 13% of control, respectively (p less than 0.01), while the corresponding responses after alpha-MD administration were 39 and 61% of control (p less than 0.05). Neurochemical findings suggest that 6-OHDA affected noradrenergic (NA), dopaminergic (DA), but not serotonergic (5HT) neurons, and that 5,6-DHT affected 5HT but not NA and DA neurons. We conclude that the circulatory effects of clonidine and alpha-MD are mediated through both central NA and 5HT neurons.

Acute carpal tunnel syndrome a rare complication of chondrocalcinosis

Acute carpal tunnel syndrome is rare and usually is secondary to trauma, burns, infection or acute rheumatoid arthritis. A case is presented in which the acute syndrome was produced by Chondrocalcinosis (pseudogout or calcium pyrophosphate disease) of the wrist.