Selenium in malnourished Sudanese children: status and interaction with clinical features

Plasma selenium (Se), haemoglobin (Hb) and packed cell volume (PCV) were measured in 53 malnourished Sudanese children, age 6-36 months, and 11 children who had tuberculosis. Twelve healthy well-nourished children served as controls. The mean (+/- SD) plasma Se (mg/kg) was 0.05 (0.036), 0.070 (0.040), 0.063 (0.015), 0.73 (0.012), 0.082 (0.014) in children with kwashiorkor/marasmic kwashiorkor (oedematous group), marasmus, tuberculosis and healthy controls. The mean Se level in the various groups showed a significant difference (p < 0.002). Whereas the oedematous group differed significantly from the rest, there was no difference between the means of the marasmic, underweight, tuberculosis patients and controls. The mean plasma albumin (+/- SD) in oedematous group was 19.6 (6.6) g/l and ranged between 22.6 (5.0) and 33.1 (3.0) in the other groups. A significant positive correlation was found between plasma Se level, albumin, Hb and PCV (respectively, r = 0.46, p < 0.0001; r = 0.37, p < 0.001; r = 0.36, p < 0.002).

[Multiple finger geodes in children]

Three pediatric patients with multiple geodes in the fingers are reported. This condition occurs mainly between one and three years and at seven years of age and is more common in winter. Affected fingers are swollen. Roentgenograms disclose several small lucent defects which are usually located in the middle phalanx. Several fingers are usually involved. The erythrocyte sedimentation rate is increased in virtually every case. Resolution occurs spontaneously within a few weeks or months. There is no tendency towards recurrence. Although the condition is inflammatory, exposure to cold is probably a precipitating factor.

Free fatty acids in serum of patients with acute necrotizing or edematous pancreatitis

Serum concentrations of free fatty acids (FFA) were assayed in 20 patients with acute necrotizing pancreatitis (ANP). Pancreatic and peripancreatic fat necrosis was verified on operation and/or by contrast-enhanced computed tomography. For comparison, 20 patients with acute edematous pancreatitis (AEP) were examined. On admission, FFA serum levels were 1.14 +/- 0.12 (SEM) mmol/L in ANP and, thus, significantly (p < 0.03) higher than in AEP (0.78 +/- 0.09 mmol/L). The two groups also differed in the later course: in ANP, the FFA values remained raised (d 5-11:0.86 +/- 0.13 mmol/L; p > 0.05 vs day 1), whereas in AEP, the FFA concentrations normalized within 1 wk (d 2-4:0.52 +/- 0.11 mmol/L; d 5-11:0.39 +/- 0.05 mmol/L; p < 0.05 vs day 1 and p < 0.01 vs ANP). Serum FFA correlated positively with C-reactive protein levels (rs = 0.42; p < 0.01), but has less discriminating potency between ANP and AEP. In AEP, the initial peak may correspond to the disease outburst itself and to unspecific stress. In ANP, the higher and sustained elevation of FFA may predominantly mirror the ongoing pancreatic parenchymal and extrapancreatic fat necrosis, and be pathophysiologically relevant, especially in view of significantly reduced serum albumin levels in ANP.

Randomised controlled trial of albumin infusion in ill preterm infants

We assessed the effect of albumin infusion on weight loss and ventilation requirement in sick premature infants. Thirty infants, median gestational age 29 weeks, were entered into a randomised controlled trial, at a median of 2 days of age. The infants, all with an albumin level < or = 30 g/l, received either 5 ml/kg of 20% albumin or 5 ml/kg of their maintenance fluids (placebo), both given as part of the total daily fluid requirement. The response to the infusion was assessed by comparing two periods; 12 h immediately prior to the infusion and 12-24 h after the infusion. Albumin infusion was associated with a significant increase in albumin level and a significant reduction in weight, but in the placebo group there was a significant increase in weight. There were, however, no significant changes in the peak inspiratory pressure in response to either infusion. There was only a modest reduction (< 15%) in the inspired oxygen concentration, which occurred in both groups, but reached statistical significance only following the albumin infusion. We conclude that our results suggest that albumin infusion in "hypoalbuminaemic" sick preterm infants is unlikely to alter their respiratory status.

Etiology and treatment of fluid retention (hydrops) in Ménière's syndrome

For years low sodium diets have been recommended in the treatment of Ménière's syndrome. Elevated levels of insulin play an important role in sodium retention in renal tubules. Insulin production is stimulated by high carbohydrate diets. Adrenaline, cortisone, and glucagon levels may be increased by stress or food or inhalant allergies, further elevating insulin levels. The end result of prolonged hyperinsulinemia includes vasoconstriction and eventually arterial smooth muscle hypertrophy. Individual susceptibility to Ménière's syndrome may occur as a result of inflammatory changes in the endolymphatic sac or cochlear aqueduct secondary to primary or latent viral infections, thus predisposing to fluid retention. Long term medical treatment of Ménière's should be directed towards preventing sodium retention through sodium restriction and carbohydrate management. Other factors including stress and allergy should also be considered.

Effect of daily immersion on the edema of pregnancy

To evaluate whether pregnant women become refractory to the effects of immersion, we studied 11 healthy women from 26 to 38 weeks' gestation, immersed in 34 degrees C shoulder-deep water for 4 or 5 consecutive days. The daily immersion diuresis showed no change throughout the study (p = 0.98: mean, 145 ml, 159 ml, 159 ml, 173 ml, 184 ml, day 1 through day 5, respectively). The range of urine volumes was broad, 35 to 675 ml, depending on the subject's degree of edema. Immersion produced a significantly larger diuresis compared with preimmersion values, 162 ml versus 110 ml. Maternal blood pressure and heart rate consistently fell during immersion, and this effect was maintained for each day studied. The subjects' hematocrit, hemoglobin, and total protein were unchanged from a preimmersion sample on day 1 to a postimmersion sample on the last day of the study. The results of this study indicate that pregnant women do not become refractory to the hemodynamic and diuretic effects of immersion.

An evaluation of 2-benzyl-1-naphthol (DuP 654) analogs as systemic anti-inflammatory agents

DuP 654 (2-benzyl-1-naphthol) is a topically active anti-inflammatory agent that was evaluated in phase II clinical trials as an anti-psoriatic agent. The compound is a potent 5-lipoxygenase inhibitor and exhibits inhibitory activity against lipopolysaccharide-stimulated release of interleukin-1 from human monocytes. DuP 654 cannot be used as a systemic anti-inflammatory compound due to its rapid and extensive metabolism. Fifteen analogs were synthesized in an attempt to block the systemic route(s) of metabolism. The compounds were evaluated (IP and PO) in the rat carrageenan paw edema inflammation model with plasma samples taken at 1, 2, 3, and 4 hours post-dose. Substitutions at the 4- and/or 8-positions on the naphthol, and/or on the benzyl group of the DuP 654 molecule were unsuccessful in achieving an analog which displayed both oral activity in the inflammatory model and high plasma levels without manifesting toxicity. The low plasma levels of some analogs may indicate poor absorption, high volume of distribution, or that the substitution did not inhibit the high hepatic "first-pass" metabolism observed with DuP 654. Other compounds not studied but similar in structure to DuP 654 may exhibit rapid and extensive metabolism.

Transient myopia with severe chemosis associated with exacerbation of disease activity in systemic lupus erythematosus

A 46-year-old woman with systemic lupus erythematosus (SLE) developed bilateral transient myopia and periorbital edema with severe chemosis. Her myopia was ascribed to a refractive abnormality that was caused by curvature change and anterior displacement of the lenses and the ciliary bodies due to anterior ocular edema. The conditions were not associated with systemic edema or abnormality in the fundi and responded well to the systemic administration of corticosteroid. The course of the ocular symptoms paralleled changes of serum CH50 and anti-dsDNA antibody levels. Thus it was concluded that her ocular symptoms were closely related to activity of her SLE and may be considered a feature of SLE.

[Azosemide--a loop diuretic with protracted effect]

Azosemide, a novel loop diuretic that has been available for the past few years, acts qualitatively like thiazide, viz by prolonging the diuretic effect with, however, only a slight delay in the onset of diuresis, in combination with the quantitative effect of previous loop diuretics, i.e. large excretion volumes. On the basis of experience gained to date, specific indications will presumably be cardiac and renal edema and ascites, also as long-term treatment. Provided that no NaCl or volume deficiency presents, side effects are insignificant.

Long-term survival of a baby with homozygous alpha-thalassemia-1

Triplets born to a Chinese woman consisted of 2 healthy boys and a girl with hemoglobin Bart's hydrops syndrome. The girl with hemoglobin Bart's hydrops syndrome, confirmed by gene analysis to be homozygous for alpha-thalassemia-1, survives for 27 months at the time of reporting. The dilemma in sustaining her life and the availability of other therapeutic options are briefly discussed. This is the third case report of homozygous alpha-thalassemia-1 with long-term survival.

[Dynamics of various blood electrolytes in patients with Menière's disease after desiccation]

The serum concentrations of Na, K, Ca, and Cl were measured in 25 patients with Meniere's disease. In the patients with hydrops, the concentrations of K, Ca, and Cl were initially increased and during dehydration slightly decreased. In the patients without hydrops, the concentration of K and Ca was near the upper limit and that of Cl was within normal limits. No specific patterns of variations of C, Ca, Cl concentrations were detected in the patients without hydrops. The K:Cl, Ca:Cl and K:Ca ratios were stable in the patients without hydrops and unstable in the patients with hydrops. They depended on the time of dehydration, which suggests that in patients with hydrops compensatory and adaptive mechanisms are persistent and flexible.

A novel neutrophil chemoattractant generated during an inflammatory reaction in the rabbit peritoneal cavity in vivo. Purification, partial amino acid sequence and structural relationship to interleukin 8

An inflammatory reaction was induced in vivo by injection of zymosan into the peritoneal cavity of the rabbit. The inflammatory exudate was found to contain oedema-inducing and neutrophil chemoattractant activity when assayed in rabbit skin in vivo, using 125I-albumin and 111In-neutrophils. This activity was additional to that of complement fragment C5a, which was removed by an affinity gel. Two chemoattractants were isolated by cation-exchange, gel-filtration and reversed-phase h.p.l.c. One of these, which ran as a single band of 6-8 kDa on SDS/PAGE, was subjected to N-terminal sequence analysis without reduction and alkylation of cysteine residues. Positive identification of 28 of the first 31 amino acids revealed a rabbit homologue of interleukin-8 (75% sequence identity with human interleukin-8). The demonstration of interleukin-8 as a major neutrophil chemoattractant in an inflammatory reaction in vivo provides the basis for further investigations into the role of this cytokine in the inflammatory process.

Effect of posture on plasma atrial natriuretic hormone and renal function during salt loading in patients with and without postural (idiopathic) edema

The effect of posture on plasma atrial natriuretic hormone (ANH) and renal function was studied in subjects with idiopathic edema. Sixty-five subjects with edema but with no clinical evidence for cardiac, renal, or pulmonary diseases were studied after they had been off all medication for 1 week or more. They had nothing by mouth after midnight and were admitted to the Clinical Research Center at 0800 h. They voided, were weighed, and had their blood pressure and pulse measured in the recumbent and upright positions. A needle was inserted, and subjects were recumbent for 0.5 h, after which blood was drawn for measurement of plasma ANH, serum sodium, potassium, and (in 35 subjects) creatinine. They were then given 150 mL 0.14% sodium chloride solution to drink every 0.5 h for the next 6 h. Urine was collected every 0.5 h for measurement of sodium, potassium, and creatinine. After 4 h of recumbency repeat blood samples were drawn, subjects ambulated for 2 h, after which final repeat blood samples were drawn. Subjects were considered to have postural edema if their upright urinary sodium/previous 2-h urinary sodium was less than 33%, and to have a normal response if it was 33% or more. The clinical characteristics of the 34 patients with postural edema and 31 patients with a normal response were similar. Plasma ANH levels (initial, after oral saline, and after standing) were similar in the two groups, and there was no relationship between changes in ANH and urinary sodium with standing. In conclusion, under conditions of mild oral sodium chloride loading, changes in plasma ANH do not cause the abnormal sodium retention found in patients with postural edema.

The effect of caput succedaneum on oxygen saturation measurements

Advances in oximetry have allowed the obstetrician to measure oxygen saturation in the fetus with non-invasive transcutaneous techniques. The influence of caput succedaneum formation on the oxygen saturation results obtained with a pulse oximeter was studied in 30 newborn infants. Caput was associated with a reduced oxygen saturation reading (mean reduction of 15%; P less than 0.001). This effect is partly due to a true drop in local tissue oxygenation but is exacerbated by a systematic error intrinsic to the physics of spectrophotometry. If continuous intrapartum oximetry is ever to become a part of routine obstetric monitoring then probes that pass through the cervix beyond the caput of the presenting part will be required if erroneously low readings are to be avoided.

Negative endocrine control system for inflammation in rats

Inflammatory processes may be suppressed by endogenous mechanisms such as release of adrenocorticosteroid hormones through stimulation of the hypothalamus-pituitary-adrenal axis. In the present study, the relationship between the temporal development of carrageenan-induced edema in the hindlimb of the rat and release in plasma of the principal endogenous adrenocorticosteroid of the rat corticosterone was investigated. Suplantar injection of carrageenan produced a biphasic increase in basal plasma corticosterone levels that was not attributed to diurnal variation. The plasma level of corticosterone increased rapidly after injection of carrageenan and peaked 12-fold at 20 min. This first phase increase was attributed to the stress of the injection since it was mimicked by subplantar injection of saline. The second phase of corticosterone release was gradual and peaked 12-fold 7 hr after injection of carrageenan. The second phase was not elicited by subplantar injection of saline. When the hypothalamus-pituitary-adrenal axis is impaired via hypophysectomy, carrageenan-induced edema is more intense and lasts longer than in control rats. The results demonstrate that adrenocorticosteroid hormones are released as a result of the stress of injection and by the inflammatory response. Release of adrenocorticosteroids acts as a feedback mechanism to suppress the inflammatory response.

[A controlled study on edema in elderly inpatients]

The clinical background relating to edema in elderly inpatients was investigated, in terms of various items in elderly (aged greater than or equal to 65) cases with edema (n = 96) and without edema (controls, n = 95). Both groups were matched for sex, age, and underlying diseases. As compared with the control patients, the patients with edema had longer hospital stays with more disabled status, and showed less activity of daily living (ADL). The rates of bed-restricted patients, dementia patients, and patients with decubitus, muscle atrophy, or incontinence were found to be significantly higher in the patients with edema. The measurement of biochemical parameters revealed that the patients with edema had significantly lower levels of serum albumin, Na, Cl, creatinine, and uric acid, in contrast to higher levels of C-reactive protein. According to the classification of the assumed causes of edema, we divided the patients with edema into five groups; group 1 (n = 33): edema associated with immobilization, group 2 (n = 18): edema due to heart failure, group 3 (n = 15): edema on paretic limbs, group 4 (n = 6): edema due to hypoproteinemia, group 5 (n = 5): edema associated with liver cirrhosis. Both group 1 and group 4 patients had lower levels of hemoglobin and albumin, whereas group 3 patients had higher scores of ADL, higher blood pressure, and higher levels of hemoglobin and albumin. These results suggest that immobilization and restriction in bed, as well as malnutrition, were important factors in causing edema in elderly inpatients.

Plasma concentration of atrial natriuretic factor in idiopathic oedema

Low level of plasma atrial natriuretic factor (ANF) under altered dietary sodium and its elevation during bigeminy were found in a 40-year-old woman with idiopathic oedema. The natriuretic effect of this peptide and the role of renin-angiotensin-aldosterone system in oedema formation in this disorder are discussed.

Heparin, a potent releasing agent of extracellular superoxide dismutase (EC-SOD C), suppresses ischaemic paw oedema in mice

Heparin (2,000 U/kg, i.v.) increases the plasma superoxide dismutase (SOD) activity by 2-3 times after 5 min. followed by a gradual decrease. A high dose of heparin (4 x 10(3) and 10 x 10(3) U/kg) exhibits a lower increase in the release of SOD. Ischaemic paw oedema in mice was suppressed by various types of SOD and heparin also suppresses this oedema. The dose-dependent curve of heparin of oedema suppression corresponds well with the increased plasma level of SOD. Inducibility with heparin, slow clearance from the bloodstream and blocking of oedema suppression by the copper chelator, diethyldithiocarbamate (DDC), suggest that the oedema suppressing SOD was the extracellular (EC)-SOD C. Other anticoagulants such as citrate and EDTA had no effect. Chondroitin sulphate A and C or carrageenan exhibited weak suppression. A complex of EC-SOD C and heparin appears not to bind to the endothelium in contrast to the injected free EC-SOD C. When heparin is re-injected, more than 1 week was required to get the same degree of oedema suppression. This indicates the necessity of newly synthesized enzyme. A biological role for heparin-induced release of plasma SOD is demonstrated for the first time in this investigation.

Udder edema in cattle: effects of diuretics (furosemide, hydrochlorothiazide, acetazolamide, and 50% dextrose) on serum and urine electrolytes

Blood and urine chemical values at parturition in clinically normal Holstein cows (n = 12) were compared with the same values in Holstein cows developing udder edema (n = 12). There was no statistically significant mean difference between the 2 groups for the serum and urine chemical data. Furosemide (500 mg) given IV caused a significant increase in serum calcium and sodium, urine chloride, potassium, and sodium, and fractional excretional ratio of chloride, potassium, and sodium. There was a significant mean decrease in the serum potassium, urine creatinine, osmolality, pH, and specific gravity. Hydrochlorothiazide (250 mg) given IV caused a significant mean increase in serum chloride, urine chloride, potassium, and sodium, and fractional excretion ratio of chloride, potassium, and sodium. There was a significant mean decrease in serum potassium and sodium, urine osmolality, pH, and specific gravity. Acetazolamide (500 mg) given IV caused a significant mean increase in blood urea nitrogen, serum chloride and glucose, urine sodium, and fractional excretion ratio of sodium, while causing a significant mean decrease in serum potassium, sodium, and phosphorus, and urine creatinine. Dextrose (500 g) given IV as a 50% solution caused a statistical mean increase in serum glucose, urine chloride, potassium, and sodium, and fractional excretion ratio of chloride and potassium. A statistical mean decrease occurred in the packed cell volume, blood urea nitrogen, serum calcium, potassium, sodium, and phosphorus, urine creatinine, osmolality, and pH.

Ulcerated edematous limbs: effect of edema removal on transcutaneous oxygen measurements

We studied the effect of edema removal on transcutaneous oxygen tension (TcPO2) in eight patients with leg ulcers. An external pneumatic compression device was effective in removing edema from the ulcerated limbs over a 5-day course of treatment, at which time all treated limbs were clinically free of edema. TcPO2 levels at room air at the ulcer site were markedly reduced when compared with the control chest site, both before and after external pneumatic compression device therapy (p less than 0.001). Edema removal, however, did not significantly alter TcPO2 values (p greater than 0.9). No significant positional effects on TcPO2 values were noted with patients supine, sitting, or with the affected limbs elevated. Five patients (63%) had increased TcPO2 values adjacent to the ulcer site when receiving supplemental oxygen. For these patients, TcPO2 values increased after oxygen inhalation, both before and after edema removal (p less than 0.05). We conclude that TcPO2 values are markedly reduced in ulcerated edematous limbs. Edema, however, may not constitute a barrier to oxygen diffusion through the skin and does not account for the low TcPO2 values in the ulcerated edematous limb. Therefore the positive therapeutic effect of removing edema is unlikely to be related to better oxygenation of the tissues.

Rhabdomyolysis, oedema and arterial hypertension: different syndromes related to topical use of 9-alpha-fluoroprednisolone

Over a one year period we detected five cases of iatrogenic mineralocorticoidism secondary to topical application of creams containing 9-alpha-fluoro-prednisolone. Although the same product was involved in all cases, the clinical features differed and included two cases of myopathy and hypokalemic rhabdomyolysis, one of oedema and two of arterial hypertension. Discontinuation of treatment and administration of potassium supplements produced a rapid recovery and all patients remain well six months later.

Assessment of plasma leukotriene and prostaglandin levels during adjuvant arthritis and kaolin-induced paw oedema in rats

Plasma levels of some arachidonic acid metabolites were investigated in acute and chronic models of inflammation in rats. As a model of chronic inflammation, adjuvant arthritis in rats induced by the injection of Freund's complete adjuvant, and as an acute model for inflammation, kaolin-induced paw oedama were used. Plasma leukotriene(LT) C4-like and prostaglandin(PG) E2-like activities were quantitated by bioassay in guinea-pig ileum and rat stomach fundus respectively. In the course of adjuvant arthritis, plasma levels of LTC4- and PGEi2-like activities were increased. Plasma LTC4-like activity reached a maximum within 3 weeks, while PGE2-like activity reached a maximum 10 days after adjuvant injection. In the early phase of adjuvant arthritis, levels of both LTC4- and PGE2-like activities were found to be low but both activities were increased in the late phase of inflammation.