Pathogen-specific antibody profiles in patients with severe systemic infections

Infections are often caused by pathobionts, endogenous bacteria that belong to the microbiota. Trauma and surgical intervention can allow bacteria to overcome host defences, ultimately leading to sepsis if left untreated. One of the main defence strategies of the immune system is the production of highly specific antibodies. In the present proof-of-concept study, plasma antibodies against 9 major pathogens were measured in sepsis patients, as an example of severe systemic infections. The binding of plasma antibodies to bacterial extracellular proteins was quantified using a semi-automated immunoblot assay. Comparison of the pathogen-specific antibody levels before and after infection showed an increase in plasma IgG in 20 out of 37 tested patients. This host-directed approach extended the results of pathogen-oriented microbiological and PCR diagnostics: a specific antibody response to additional bacteria was frequently observed, indicating unrecognised poly-microbial invasion. This might explain some cases of failed, seemingly targeted antibiotic treatment.

[Examination of the total protein concentration and gamma-glutamyltransferase (gamma-GT) in calves during the first 14 days of life and their significance for predictions of health status in the first two postnatal weeks]

The objective of the present paper was to examine the development of the total protein concentration in blood serum and the gamma-GT activity in 49 calves in relation to the health status during the first 14 days of life. For this purpose, blood samples were taken immediately after birth of the animals, after 6, 12, 18 and 24 hours and from then onwards once a day with the calves being subject to a thorough clinical examination each time. All calves received pooled colostrum. At the end of the experiment, the calves were subdivided into three groups on the basis of their health status, i.e. control calves, calves with a slight or moderately severe disease and calves suffering from a severe disease. In all three groups the total protein concentration increased significantly after the colostrum intake and decreased slowly from the 2nd day of life onwards. The gamma-GT activity as well increased significantly after the colostrum intake and decreased rapidly after 12th hour of life and progressively in the further course of the experiment. Both parameters varied considerably from one calf to the next and no statistically significant differences in these parameters between the three groups could be found. It can thus be deduced that the total protein concentration in blood serum and the gamma-GT activity do not allow any predictions about the development of the health status during the first 14 days of life to be made.

Emergency thoracotomy in an urban community hospital: initial cardiac rhythm as a new predictor of survival

Several authors have reviewed their experience with emergency thoracotomy in the university hospital setting. However, physicians in urban community hospitals are treating increasing numbers of patients who require emergency thoracotomy. To compare such experiences, the charts of all patients who underwent emergency thoracotomy in an urban community hospital during the years 1981 and 1982 were reviewed. In addition, the presenting cardiac rhythm was evaluated as a potential new prognosticator for survival in these patients. Forty-seven thoracotomies were performed during the two-year period. Thirty-nine (83%) were for penetrating trauma, of which 31 (66%) were for gunshot wounds and eight (17%) were for stab wounds. Eight patients (17%) underwent thoracotomy for blunt trauma. Of the 13 patients (28%) who survived and were discharged from the hospital, eight (17% of the total) had no neurological deficit. Twenty-five patients (53%) presented in sinus rhythm, 23 in sinus tachycardia, and two in normal sinus rhythm. All survivors beyond the operating room were in this group (P less than 0.001). Twenty-two patients (47%) presented in bradyasystolic rhythms, including bradycardia (four patients), agonal ventricular rhythm (five patients), ventricular fibrillation (three patients), and asystole (ten patients). None of these patients survived. The outcome data for community-hospital emergency thoracotomy are comparable with those of university centers where similar reviews were undertaken. The presenting cardiac rhythm is an accurate prognosticator of survival in patients undergoing emergency thoracotomy. Patients who present with sinus rhythms deserve aggressive resuscitation and emergency thoracotomy. Emergency thoracotomy does not improve the uniformly poor prognosis in patients presenting in bradyasystolic rhythms.

[Hemorheologic effects of ioxaglate: a contribution to an interpretation of the effect of hyperosmolar roentgen contrast media on the fluidity of erythrocytes]

Almen and Aspelin have shown that the use of non-ionic radio contrast media allows the iodine concentration to be increased (which is desirable because of its effect on radio opacity) without a very large increase in osmolarity (which is undesirable because it impairs the fluidity of erythrocytes). This latter effect can also be diminished by reducing the osmolarity of a dimeric contrast medium as has been achieved by incorporating more iodine atoms into the molecule in the case of Ioxaglate (Hexabrix). In various microrheological tests systems, the fluidity of packed red cell suspension, the corrected filtration rate though 5 micron pores and the relative apparent viscosity of blood-contrast media mixtures (1 to 50% concentration) were determined in experiments comparing this compound with Urografin 76 of the same iodine content. In all systems, the former showed fewer rheological effects. In whole blood viscometry, this can be detected only after appropriate corrections for the effects of the two contrast media on hematocrit and plasma viscosity. As there is a more pronounced water shift from the cells to the plasma, Urografin tends to reduce the viscosity of the plasma-contrast media mixture. The concomitant reduction in MCV and hematocrit level tends to conceal the macrorheological influence of strong cell stiffening. This microrheological effect of the dehydrated cells becomes immediately obvious when the viscometric data are corrected for hematocrit value and plasma viscosity effects.