Iron metabolism in burned children

The administration of iron supplementation in children with burns has been a subject of controversy. Recent studies argue against its use in the acute phase of stress. To assess whether iron metabolism parameters show significant differences in the acute phase and the recovery phase of burn, 21 patients (age range: 17 months to 13 years) with burns of more than 10% of body surface who had not received blood transfusions or iron supplementation were studied. Sideraemia, ferritin, transferrin, transferrin saturation index (TSI) and C-reactive protein (CRP) were assessed both in the acute and the recovery phase after burn. Sideraemia, transferrin, and TSI were significantly lower in the acute than in the recovery phase (17.3 +/- 3 vs 53.8 +/- 6.6 microg/dL, 190.5 +/- 15 vs 287.9 +/- 14.3 mg/dL and 7.7 +/- 1.3 vs 15.4 +/- 1.6%, P < 0.0001, P < 0.001 and P = 0.0006, respectively) while plasma ferritin and CRP were significantly higher (84.7 +/- 8.8 vs 43.1 +/- 8.5 ng/mL and 9.5 +/- 1.5 vs 0.7 +/- 0.2 mg/dL, P = 0.016 and P < 0.0001, respectively). When the above parameters were analysed based on age (< or = 2 years, > 2 years), the observed differences persisted.

CONCLUSION

Hyposideraemia is a frequent finding in the acute phase of paediatric burns and is accompanied by increased ferritin levels and decreased transferrin concentrations. The low iron values tend to recover without the use of iron supplementation suggesting an endogenous block of iron release in the acute phase and indicates that iron therapy should be not recommended in the initial period of stress of the burned patient.

CD95 expression and function on lymphocyte subpopulations in common variable immunodeficiency (CVID); related to increased apoptosis

Apoptosis is now recognized as a central process of development and disease, and it has been proposed as one of the mechanisms that may account for the lymphopenia seen in some diseases. In this study we measured spontaneous apoptosis and CD95 expression on different cell subpopulations from CVID patients, using flow cytometric techniques. We divided our patients into two groups according to their CD4+ and CD4+CD45RA+ cell counts. Our results clearly show increased spontaneous apoptosis and CD95 expression on the CD4+ and CD4+CD45RA+ subsets from lymphopenic CVID patients compared with normal subjects and disease controls. Interestingly, our lymphopenic CVID patients presented a profound reduction in absolute counts, mainly affecting the CD4+CD45RA+ subpopulation. We also found a statistically significant direct correlation between absolute numbers of CD4+CD45RA+ T cells and spontaneous apoptosis on the same subset in CVID patients, but attempts to induce CD95-mediated apoptosis were unsuccessful despite increased CD95 expression on CD4+ T cells. These findings suggest that apoptosis could be one of the mechanisms implicated in the significant lymphopenia present in these patients.

Role of the intensive care unit in children undergoing bone marrow transplantation with life-threatening complications

The role of support measures in the Intensive Care Unit for bone marrow transplant recipients has been controversial. Data from 176 pediatric bone marrow transplants were retrospectively analyzed to ascertain the probability, causes, risk factors and survival for life-threatening complications requiring intensive care. Ninety-two patients underwent allogeneic BMT and 84 autologous BMT between January 1991 and December 1995. Thirty-one ICU admissions were recorded. The most frequent causes were acute respiratory failure (n = 15, mostly interstitial pneumopathies), septic shock (n = 5) neurological disorders (n = 5) and heart failure (n = 2). The cumulative incidence of an ICU admission at 20 months post-transplant in patients with an allogeneic BMT was 25.7% (CI: 16.4-35.1), compared with 10.8% (CI: 4.2-17.5) in those with an autologous graft (P = 0.04). ICU admission frequency was maximum during the first 2 months post-transplant. All complications in patients with autologous transplants appeared during the first 5 months post-transplant. Among patients with allogeneic grafts, four were later admitted to the ICU, at 7, 9, 12 and 20 months post-transplant, respectively. The main risk factor for ICU admission was acute GVHD grades III-IV. No differences were found between patients with allogeneic transplants with GVHD grades 0-II and those undergoing autologous transplant. In contrast, differences were highly significant between patients undergoing allogeneic transplants with GVHD grades III-IV and those with GVHD grades 0-II or autologous transplants. No differences were observed between allogeneic and autologous transplants in terms of causes for ICU admission, duration of stay, hours on mechanical ventilation, hours on inotropic drug therapy and numbers of organs failing. Neither were differences found in ICU discharge survival between patients with allogeneic (50%, CI: 29.1-70.9) and autologous (66.7%, CI: 29.9-89.1) transplants. ICU discharge survival in patients admitted for lung disease was 28.6% (CI: 12.1-65.6) but 76.5% (CI: 41.9-87.8) in patients admitted for other causes (P = 0.007). ICU discharge survival in mechanically ventilated patients was 46.2% (CI: 27.0-65.4), significantly lower than nonventilated patients (100%). Three-year survival in all transplanted patients admitted to the ICU was 29.7% (CI: 13.1-45.0) compared with 70.2% (CI: 62.7-77.6) in patients not requiring ICU admission (P<0.001). Although a complication requiring admission to the ICU is, as confirmed by multivariate analysis, an unfavorable factor in long-term survival of transplanted patients, it must be emphasized that three of every 10 patients admitted to the ICU were alive and well at 3 years. Intensive care support in these patients can be life-saving.

Severe systemic inflammatory response syndrome with shock and ARDS resulting from Still's disease: clinical response with high-dose pulse methylprednisolone therapy

Adult-onset Still's disease, the adult variant of the systemic form of juvenile arthritis, is an uncommon systemic inflammatory disorder of unknown etiology characterized by high spiking fevers, neutrophilic leukocytosis, arthritis, and an evanescent rash. There is often a delay in reaching a firm diagnosis. Differential diagnoses include infection, malignancy, and various immunologic disorders. Increased ferritin levels are of particular value in establishing the diagnosis. Clinical response to high-dose corticosteroids may be dramatic. We report a case of a 29-year-old woman who had recently been investigated for fever of unknown origin, and who presented to our hospital with high fever and hypotension. Her condition rapidly deteriorated with the development of ARDS, disseminated intravascular coagulation, and shock. The patient had a markedly elevated serum ferritin concentration of 26,000 ng/mL. High-dose pulse methylprednisolone therapy resulted in a remarkable clinical improvement. Such a severe case of systemic inflammatory response syndrome, masquerading as septic shock, has not been reported previously.

Characterization and distribution of an oncofetal antigen (M2A antigen) expressed on testicular germ cell tumours

M2A antigen is an oncofetal antigen associated with germ cell neoplasia, present in testis on fetal gonocytes and re-expressed on carcinoma in situ (CIS) and germ cell tumours. We developed a panel of monoclonal antibodies (mAb), M2A (IgG2a), D1-26 (IgG2b) and D2-40 (IgG1), to this antigen in order to characterize its structure and study its distribution among germ cell tumours. M2A antigen was purified by sequential lectin and antibody affinity chromatography and characterized as a monomeric M, 40 000 surface sialoglycoprotein, extensively glycosylated with O-linked carbohydrate structures, but devoid of N-linked sugars. Terminal sialic acid residues were required for reactivity with mAb M2A and D1-26, but not D2-40. Sections of 69 testicular germ cell tumours, fixed in formalin and embedded in paraffin, were stained with mAb D2-40 to examine the distribution of M2A antigen. Uniform membrane staining was observed in seminomas, and focal staining in 69% of embryonal carcinomas, 29% of teratomas and 25% of yolk sac tumours. CIS in the vicinity of all germ cell tumours also displayed uniform membrane staining. The characterization of M2A antigen, and the development of mAb which react with it in conventionally preserved archival specimens, provide important initiatives to study the origin and progression of germ cell neoplasia.

Multitargeted antifolate LY231514 as first-line chemotherapy for patients with advanced non-small-cell lung cancer: A phase II study. National Cancer Institute of Canada Clinical Trials Group

PURPOSE

To evaluate the efficacy and safety of the multitargeted antifolate LY231514 (MTA) in patients receiving initial chemotherapy for unresectable, advanced non-small-cell lung cancer (NSCLC).

PATIENTS AND METHODS

Patients with measurable, advanced NSCLC who had not received previous chemotherapy for advanced disease were considered for this study. Eligible patients who gave written informed consent initially received MTA 600 mg/m(2) intravenously (IV) for 10 minutes every 3 weeks. After three patients received treatment at this dose, the dose was reduced to 500 mg/m(2) IV at the same infusion time and frequency because of toxicity seen in this study and another Canadian MTA trial in colorectal cancer. Patients received up to four cycles after complete or partial remission or six cycles after stable disease was documented.

RESULTS

Thirty-three patients were accrued onto the study. All were assessable for toxicity, and 30 patients were assessable for response. All but one patient had an Eastern Cooperative Oncology Group performance status score of 0 or 1, 18 patients (55%) had adenocarcinoma, and nine patients (27%) had squamous cell carcinoma. Twenty-five patients (76%) had stage IV disease, and the remainder had stage IIIB disease at trial entry. Seven patients experienced a confirmed partial response and no complete responses were seen; thus, the overall response rate was 23.3% (95% confidence interval, 9.9% to 42.3%). The median duration of response was 3.1 months (range, 2. 3 to 13.5 months) after a median follow-up period of 7.9 months. Four (67%) of six patients with stage IIIB disease and three (12.5%) of 24 with stage IV disease responded to treatment. Four patients (13.3%) experienced febrile neutropenia and 13 (39%) experienced grade 3 or 4 neutropenia, whereas only one patient (3%) developed grade 4 thrombocytopenia. Nonhematologic toxicity was generally mild or moderate, but 39% of patients developed a grade 3 skin rash. Most other toxicities comprised grade 1 or 2 stomatitis, diarrhea, lethargy, and anorexia. Ten patients stopped protocol therapy because of toxicity.

CONCLUSION

MTA seems to have clinically meaningful activity as a single agent against advanced NSCLC. Toxicity is generally mild and tolerable. Further study of this agent in combination with cisplatin and other active drugs is warranted in this disease.

[A study of the motor and sensory cortex using functional magnetic resonance: tasks of active and passive movement]

INTRODUCTION AND OBJECTIVE

The objective of this study was to locate the rolandic area (pre- and post-central) by means of functional magnetic resonance imaging (FMRI) and define its correspondence on a Talairach map, whilst active and passive movements of the dominant hand were performed.

MATERIAL AND METHODS

Ten healthy volunteers were found, 6 men and 4 women, of an average age of 26 years (range 22-33). Two appropriate tasks were designed: one involving active and one passive movement. The examination was carried out using a 1.5 Tesla (General Electric) MRI apparatus. An echo-sequence of planar echo-gradient (BOLD technique) was used, making sagittal and axial planes, parallel to the AC-PC line (anterior commissure-posterior commissure). Subsequently an anatomofunctional Talairach map was drawn for each subject, to include the information obtained on FMRI.

RESULTS

In all subjects central activity was detected in the rolandic area during the tasks involving selected active and passive movements. Overlap was seen between the pre- and post-rolandic areas with both types of tasks.

CONCLUSION

There is good correlation between the image obtained of motor-sensory activity in the rolandic zone and the Talairach anatomofunctional map.

Differential effects of dietary fat on chick plasma and liver composition and HMG-CoA reductase activity

The comparative effects of diet supplementation with 10% saturated fat rich in 12:0 and 14:0 fatty acids (coconut oil), without and with 1% added cholesterol, and with 10% unsaturated fat rich in n-3 polyunsaturated fatty acids (menhaden oil) on cholesterol metabolism in neonatal chicks were examined to clarify the different mechanisms of their hyper- and hypolipidemic action. Supplementation of coconut oil produced a significant hypercholesterolemia after 7 days of treatment, with a similar increase in the amount of both free and esterified cholesterol. Supplementation of coconut oil plus cholesterol produced a higher increase of plasma cholesterol levels (approximately two to three times higher than those found with standard diet). However, supplementation of menhaden oil induced a significant decrease in total cholesterol after only 2 weeks of treatment. Levels of plasma triglycerides did not change by coconut oil addition to the diet, but a significant increase was observed after coconut oil plus cholesterol feeding. Menhaden oil produced a transient decrease in plasma triglycerides. Hepatic 3-hydroxy-3-methylglutaryl-CoA reductase activity did not change with coconut oil treatment. However, both coconut oil plus cholesterol and menhaden oil supplemented diets drastically decreased reductase activity after 1 week of dietary manipulation. These results show that different nutrients with the same inhibitory effect on reductase activity produced opposite effects on plasma cholesterol content, suggesting the existence of important differences in the regulatory mechanisms implied in cholesterol biosynthesis and its accumulation in plasma.

Antiinflammatory activity of some extracts from plants used in the traditional medicine of north-African countries (II)

Aqueous, ethanol and chloroform extracts from Corrigiliola telephiifolia, Echinops spinosus, Kundmannia sicula, Tamarindus indica and Zygophyllum gaetulum were evaluated for antiinflammatory properties in mice (ear oedema induced by arachidonic acid) and rats (subplantar oedema induced by carrageenan) after topical or i.p. administration, respectively. Our results showed that all the plants exhibit antiinflammatory activity, since at least one extract from each plant was active in one of the experimental models. Whereas all the extracts of Corrigiliola telephiifolia and Echinops spinosus were highly active on all the experimental models assayed (values of inflammation inhibition well above 50%), poorer activity profiles were recorded in Kundmannia sicula, Tamarindus indica and Zygophyllum gaetulum. These results support the traditional uses for these plants but indicate that the active principles in the chloroform extracts are probably more active and/or are contained in larger concentrations than the principles in the polar extracts used in the traditional medicine of North-African countries.

Searching for face-specific long latency ERPs: a topographic study of effects associated with mismatching features

In a previous study [E. Olivares, M.A. Bobes, E. Aubert, M. Valdés-Sosa, Associative ERPs effects with memories of artificial faces, Cogn. Brain Res. 2 (1994) 39-48] we reported the presence of a negativity associated with mismatching features when subjects carried out a face-feature matching task whilst their evoked potentials were recorded. Since the stimuli used were learned faces (realistic drawings), for which the subjects possessed no semantic information or associated verbal labels, the mismatch negativity obtained was considered a face-specific N400. In this work we present a new experiment to study the topographic distribution of these mismatch effects. As in the above-mentioned study, in each trial the subjects observed previously an incomplete (without the eyes/eyebrows fragment) familiar face, which served as a structural context for the face recognition. The face was then completed by grafting either matching (learned) features or mismatching features (from another face). In line with neuropsychological studies on prosopagnosia and electrophysiological findings in humans and non-human primates, we found as one of the most relevant items of data that the most-posterior (principally, left occipital) cortices appear to be a region in which are located the possible neural generators of the negativity associated with the detection of incongruencies in the structure of familiar faces. We also reported a late positivity, distributed in more anterior regions, which follows the mismatch negativity. This complex N-P is interpreted as reflecting a dual process of retrieval and integration of information in memory.

Large surface of cultured human epithelium obtained on a dermal matrix based on live fibroblast-containing fibrin gels

The aim of this study was to develop a new keratinocyte culture system on a dermal equivalent suitable for skin wound closure. Our dermal matrix is based on a fibrin gel from plasma cryoprecipitate containing live human fibroblast (from human foreskin). Keratinocytes obtained from primary culture according to the Rheinwald and Green method, were seeded on the gel at different seeding ratios. In all cases, the keratinocytes plated on the dermal equivalent grew to confluence and stratified epithelium was obtained within 10-15 days in culture. Early expression of basal membrane proteins was detected by immunostaining with laminin and type IV collagen antibodies. Cell proliferation was detected both in the epidermal layer and in the fibroblast embedded in the gel as assessed by BrdU incorporation. Detachment of composite cultures from dishes or flasks is a simple and quick procedure without the need for dispase treatment. Grafting of composite cultures to nude mice gave rise to an orderly stratified, orthokeratinized epithelium resembling human epidermis. A number of advantages including a large expansion factor without the need of 3T3 feeder layer, the availability of fibrin/plasma cryoprecipitate from blood banks and the versatile manipulation of composite cultures suggest that this system could be suitable for the definitive coverage of severely burned patients.

Intestinal reperfusion-induced pulmonary edema is related to increased pulmonary inducible nitric oxide synthase activity

BACKGROUND

This study examines the hypothesis that specific inhibition of the inducible isoform of nitric oxide synthase (iNOS) will attenuate intestinal reperfusion-induced pulmonary microvascular dysfunction.

METHODS

Sprague-Dawley rats underwent intestinal ischemia-reperfusion (IR) or sham operation (SHAM). Before injury, the animals received a selective inhibitor of iNOS (S-methylisothiourea sulfate, SMT: L-N6-[1-iminoethyl] lysine L-NIL), a nonselective inhibitor of NOS (NG-nitro-L-arginine methylester, L-NAME) or vehicle (0.9% saline). IR-induced changes in pulmonary microvascular permeability were assessed by quantitating the extravasation of Evans blue dye (EBD)-bound protein into the lung. Pulmonary iNOS activity and content were assessed by radiochemical analysis and Western blot, respectively.

RESULTS

There was 60% more EBD within the lungs of animals sustaining IR when compared with controls (P < .05). Pretreatment with SMT or L-NIL totally prevented the increase in EBD extravasation associated with IR. In contrast, pretreatment with L-NAME resulted in a 10% increase in dye extravasation in those animals sustaining IR when compared with similarly injured animals receiving saline (P > .05). There was significantly greater iNOS activity and enzyme content within the lungs of animals sustaining IR compared with controls.

CONCLUSIONS

These data are consistent with the hypothesis that the release of nanomolar quantities of nitric oxide generated by iNOS contributes to IR-induced pulmonary microvascular dysfunction.

[Prognostic factors in uterine sarcomas: a 21-year retrospective study at the Clinic and Provincial Hospital of Barcelona]

BACKGROUND

Uterine sarcomas show low incidence and poor outcome despite the treatment. The prognostic factors for the survival were determined in this study.

PATIENTS AND METHODS

Thirty-nine females with sarcoma of the uterus have been studied retrospectively from January 1975 to December 1996. They were treated in the Gynecology and Radiation Oncology Departments at Hospital Clínic i Provincial of Barcelona. Thirty-seven patients had surgery, 22 radiotherapy and 4 chemotherapy. The influence on the disease-specific survival, disease-free survival, local relapse disease-free survival and metastasis disease-free survival from the following pronostic factors was studied: age, pathologic subtype, miometrial invasion, mitosis, vascular and lymphatic invasion, tumor size, stage, radiotherapy and local relapse.

RESULTS

1) The disease-specific survival at 2 and 5 years was 51.5% and 42.5% respectively, and the disease-free survival at 2 and 5 years was 39%; the incidence of local and distant relapses--was 28 and 33%. 2) The multivariate analysis showed that the overall survival and the disease free survival were affected by the vascular invasion (odds ratio [OR] 12 and 32.6, respectively) and the local failure (OR = 3 and 25.5, respectively); the only factor that affected the local relapse-free survival and metastasis free survival was the III and IV stages (OR = 5.6 in both cases).

CONCLUSIONS

In uterine sarcomas, the vascular invasion and the local relapse were prognostic factors for overall survival and for disease-free survival. In stages III and IV there was a decrease in the local relapse-free survival and metastasis-free survival. A correlation between vascular invasion and advanced stages was found. The outcome of the uterine sarcomas is poor, local and distant failure being responsible for this bad prognosis.

Heterotheca inuloides: anti-inflammatory and analgesic effect

Heterotheca inuloides Cass. (Asteraceae) is used in the traditional medicine of Mexico. The aqueous extract obtained from the flowers of H. inuloides was assessed for anti-inflammatory activity by carrageenan-induced edema test. At 100 mg/kg, i.p, it produced 29% inhibition of inflammation. Ethyl ether (HI-1), butanol (HI-2) and aqueous fraction (HI-3) were obtained from the aqueous extract. The biological assay, by carrageenan-induced edema test, gave the following values (% inhibition): HI-1, 19.9; HI-2, 58.0 and HI-3, 30.0. HI-2 was significantly more effective than HI-1 and HI-3. The dose-effect curve of HI-2 was obtained and the calculated ED50 was 29.7 (22.5-39.2) mg/kg. The peritoneal examination after the treatment with HI-2 showed that the anti-inflammatory action of H. inuloides was not due to an irritating effect at the injection site. At 50-100 mg/kg, i.p., HI-2 inhibited inflammation induced by dextran (38.9-68.1% inhibition) and arachidonic acid (0-33.9%). No effect was observed at the same doses for zymosan or C16-paf-induced edema. In addition, HI-2 reduced abdominal constrictions in mice following injection of acetic acid: at 50-100 mg/kg, it gave 73.8-78.2% inhibition. The ulcerogenic assay showed that ulcer indices after HI-2 i.p. treatment were 0.5 +/- 0.5 at 50 mg/kg and 1.2 +/- 0.4 at 100 mg/kg. The results showed related anti-inflammatory activity and the analgesic effect of HI-2.

Mother and infant smiling exchanges during face-to-face interaction in infants with and without Down syndrome

We examined social smiling in infants with and without Down syndrome, aged from 3.2 to 13.6 months old. They were videotaped during an episode of spontaneous face-to-face interaction and a subsequent mother's still-face situation. Results indicated that infants smiled longer in the spontaneous face-to-face episode than in the still-face episode, even though this result was only significant in typically developing infants. Typically developing infants also smiled for a longer period than Down's syndrome infants during the spontaneous interaction episode. Moreover, infant's smile preceded the onset of the mother's smile, but in 6.2- to 13.6-month-old typically developing infants, the probability of mothers smiling before infants increased. These findings emphasize the possible existence of differences in the development of facial expression from signs to social symbols between infants with and without Down syndrome.

Use of cyanoacrylate glue to prepare cultured keratinocyte sheets for grafting

We describe a method to prepare keratinocyte cultured sheets for grafting based on the use of an organic glue (n-butyl-2-cyanoacrylate). It is a rapid and easy method in which the cultured layers of keratinocytes remain with a surface area similar to the original cultures.

Usefulness of oral video push enteroscopy in Crohn's disease

BACKGROUND AND STUDY AIMS

Oral endoscopic examination of the small bowel is of vital importance when studying various clinical conditions. In this study we evaluate the diagnostic yield of push-type enteroscopy in patients with undiagnosed suspected clinical Crohn's disease using lower and upper endoscopy and double contrast X-ray in order to establish the diagnostic value of this instrument in the jejunum.

PATIENTS AND METHODS

Eight patients displaying symptoms of Crohn's disease, five adults with chronic diarrhea and abdominal pain and three children with retarded growth and weight loss associated with diarrhea underwent ambulatory enteroscopy using a Pentax videoenteroscope.

RESULTS

The average depth of insertion beyond the ligament of Treitz was 125 cm. Four patients (50%) were found to have macroscopic and/or microscopic lesions of Crohn's disease in the small intestine, which went unrecognized by other standard endoscopic and radiologic methods. Tolerance was good and there were no complications related to the procedure.

CONCLUSION

Oral videoenteroscopy with biopsy is a safe and useful procedure for diagnosis of Crohn's disease in selected patients with suggestive symptoms and can be of great diagnostic value after failure of conventional endoscopic X-ray methods.

N300, P300 and the emotional processing of visual stimuli

Two components of the ERPs elicited by emotional visual stimuli, N300 and P300, were investigated. The emotional charge is explained through two dimensions: arousal (relaxing (R) or activating (A)) and valence (attractive (+) or repulsive (-)). Stimuli were slides of nudes (A+), human remains (A-), landscapes (R), and buildings (neutral (N)). The peculiar structure of the stimuli, along with a distracting task which allowed us to disguise the real aim of the experiment, helped to avoid a sort of 'relevance-for-task effect', mainly related to cognitive processes, which could explain P300 reactions in response to emotional visual stimuli found in several experiments. The ERPs were recorded from 32 subjects at F3, Fz, F4, C3, Cz, C4, P3, Pz and P4. In contrast to previous studies, P300 did not show greater amplitudes in response to emotional stimuli than to N. N300 showed greater amplitudes in response to A+ at parietal sites, the greatest differences being those with respect to A-. No inter-hemispheric differences were found. N300 confirms its usefulness as a variable for studying emotional reactions to visual stimuli.