Retrospective cohort study of long-term outcomes and prognostic factors for survival after lower extremity amputation in patients with diabetes

AIMS

Lower extremity amputation (LEA) is a pivotal event for patients with diabetes. This study aimed to provide updated data on the outcomes and prognostic factors after LEA for patients with diabetes.

METHODS

This retrospective cohort study included all LEAs (n = 1081) performed at Tampere University Hospital between February 2007 and September 2020. Overall survival (OS) and major amputation-free survival were evaluated.

RESULTS

Index amputation level was below ankle in 65 % (n = 704) of patients, below knee in 14 % (n = 154) of patients, and above knee in 21 % (n = 223) of patients. In the whole population, OS was 75.8 % (CI 95 %: 73.3-78.3) at one year and 38.3 % (CI 95 %: 34.7-41.7) at five years. Higher age, peripheral artery disease (PAD), more proximal amputation level, and lower glomerular filtration rate (GFR) reduced OS. Multiple amputations and diagnosed dyslipidemia or hypertension associated with improved OS. Further, age, PAD, and GFR were identified as significant factors for major amputation free survival.

CONCLUSIONS

OS after LEA is poor. After major amputation, the risk for death is higher compared to minor amputation. Recurrent amputation is associated with improved OS. Further, ischemia and renal disease are significant factors for inferior OS.

POS0324 RISK OF CARDIOVASCULAR COMORBIDITIES IN RHEUMATIC DISEASES

Background

Cardiovascular diseases (CVD’s) are the most significant comorbidities in rheumatic diseases, causing also increased mortality. [1,2] However, there is only limited data on how the risk of CV comorbidities varies between different rheumatic diseases.

Objectives

The aim of our study was to estimate the risk of certain CV comorbidities across rheumatic diseases.

Methods

The ongoing FinnGen project links nationwide healthcare register data with genome data. The study (data freeze 7) included 321 302 individuals, and from this group we identified patients with seropositive (N=4293) and seronegative (N=1733) rheumatoid arthritis (RA), ankylosing spondylitis (AS, N=1247), psoriatic arthritis (PsA, N=1235), systemic lupus erythematosus (SLE, N=386), primary Sjogren’s syndrome (pSS, N=557) and gout (N=2178). Each patient was matched based on age, sex and municipality of residence with twenty individuals without any rheumatic conditions. The CV comorbidities studied were any CV disease (CVD), major coronary heart disease event (myocardial infarction and/or revascularization; CHD), ischemic stroke, atrial fibrillation and flutter (AF), deep vein thrombosis of lower extremities (DVT) and pulmonary embolism (PE), chronic heart failure (CHF) and valvular heart disease excluding rheumatic fever (VHD). From the prevalence of each CV disease among rheumatic disease cohorts, we calculated the risk ratio (RR) for each CV disease by comparing the prevalence of these diseases between rheumatic diseases and controls.

Results

The average age at the time of diagnosis ranged from 39.6 to 64.4 years, and the average duration of follow-up varied from 9 to 19.5 years in different rheumatic diseases. The risk for any CVD was elevated in all rheumatic disease cohorts with RR varying from 1.14 in seropositive RA to 1.65 in SLE. SLE patients carried the highest relative risk for CV comorbidities, demonstrating over 2.5-fold risk for DVT/PE (RR 3.57), stroke (RR 2.57), CHF (RR 2.64) and VHD (RR 2.98). At least two-fold risk compared to controls was identified for AF (RR 2.03), DVT/PE (RR 2.44) and CHF (RR 3.03) in patients with gout, for DVT/PE (RR 2.15) and CHF (RR 2.0) in patients with pSS, and for DVT/PE (RR 2.03) in patients with PsA. Seropositive and seronegative RA demonstrated similar CV risk profiles. In patients with seropositive or seronegative RA, PsA, pSS or SLE, DVT/PE demonstrated the highest RR’s among various CV comorbidities.

Conclusion

The risk of CV comorbidities is increased in all studied rheumatic diseases, with the largest effects observed in patients with SLE and gout. Among CV comorbidities, DVT/PE displayed the largest effect sizes in several rheumatic diseases. The current results further strengthen the importance of evaluating and treating risk factors for CV comorbidities across rheumatic diseases, focusing also to the excess risk for thromboses.

References

[1]Han C., Robinson DW Jr et al. Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. J Rheumatol. 2006;33(11):2167-2172.

[2]Avina-Zubieta JA, Choi HK et al. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum. 2008; 15;59(12):1690-1697.

Acknowledgements

Special thanks to Finnish Foundation of Rheumatology Research and the Foundation of Maire Lisko for issuing research grants to help with the research process and writing of this abstract.

Disclosure of Interests

Hanna-Kaisa Aaramaa: None declared, Pia Isomäki Speakers bureau: Speaker or chair for AbbVie, Eli Lilly and Pfizer., Consultant of: Consultant for AbbVie, Eli Lilly, Pfizer, Roche and ViforPharma., Grant/research support from: A research grant from Pfizer., Nina Mars: None declared, Mika Helminen: None declared, Anne Kerola: None declared, Antti Palomäki Speakers bureau: Lecture free from Pfizer and Sanofi, Consultant of: Consulting fee from Abbvie, Amgen and Pfizer, Kari Eklund: None declared, Javier Gracia Tabuenca: None declared, Juha Sinisalo: None declared

Risk factors for asthma after infant bronchiolitis

BACKGROUND

Five studies carried out after bronchiolitis at less than 24 months of age, with a follow-up of more than 10 years, reported that atopic dermatitis, family asthma, early-life exposure to tobacco smoke and rhinovirus aetiology were early-life risk factors for later asthma. This study evaluated the long-term outcome at 11-13 years of age of children who were hospitalized for bronchiolitis in early infancy.

METHODS

We previously prospectively followed 166 children hospitalized for bronchiolitis at less than 6 months of age until 5-7 years of age. The current study included a structured questionnaire, parental interviews, clinical examinations and bronchodilation test of 138 of those children at 11-13 years of age.

RESULTS

Respiratory syncytial virus caused 66% of the bronchiolitis cases, and nearly half of the patients were exposed to tobacco smoke in early life. Doctor-diagnosed asthma was present in 13% of the former bronchiolitis patients at 11-13 years of age. Maternal asthma was the only independently significant risk factor in early life (adjusted OR 3.45, 95% CI 1.07-11.74), as was allergic rhinitis at 5-7 years of age (adjusted OR 4.06, 95% CI 1.35-12.25).

CONCLUSIONS

After bronchiolitis at less than 6 months of age, the risk of doctor-diagnosed asthma at 11-13 years was about twice that of the general Finnish population. Maternal asthma was the only independently significant early-life risk factor for current asthma at 11-13 years of age.

Greater Success of Primary Fascial Closure of the Open Abdomen: A Retrospective Study Analyzing Applied Surgical Techniques, Success of Fascial Closure, and Variables Affecting the Results

BACKGROUND AND AIMS

The open abdomen technique is a standard procedure in the treatment of intra-abdominal catastrophe. Achieving primary abdominal closure within the initial hospitalization is a main objective. This study aimed to analyze the success of closure rate and the effect of negative pressure wound therapy, mesh-mediated medial traction, and component separation on the results. We present the treatment algorithm used in our institution in open abdomen situations based on these findings.

MATERIAL AND METHODS

Open abdomen patients (n = 61) treated in Tampere University Hospital from May 2005 until October 2013 were included in the study. Patient characteristics, treatment prior to closure, closure technique, and results were retrospectively collected and analyzed. The first group included patients in whom direct or bridged fascial closure was achieved, and the second group included those in whom only the skin was closed or a free skin graft was used. Background variables and variables related to surgery were compared between groups.

RESULTS AND CONCLUSION

Most of the open abdomen patients (72.1%) underwent fascial defect repair during the primary hospitalization, and 70.5% of them underwent direct fascial closure. Negative pressure wound therapy was used as a temporary closure method for 86.9% of the patients. Negative pressure wound therapy combined with mesh-mediated medial traction resulted in the shortest open abdomen time (p = 0.039) and the highest fascial repair rate (p = 0.000) compared to negative pressure wound therapy only or no negative pressure wound therapy. The component separation technique was used for 11 patients; direct fascial closure was achieved in 5 and fascial repair by bridging the defect with mesh was achieved in 6. A total of 8 of 37 (21.6%) patients with mesh repair had a mesh infection. The negative pressure wound therapy combined with mesh-mediated medial traction promotes definitive fascial closure with a high closure rate and a shortened open abdomen time. The component separation technique can be used to facilitate fascial repair but it does not guarantee direct fascial closure in open abdomen patients.

Chest-wall contouring surgery in female-to-male transgender patients: A one-center retrospective analysis of applied surgical techniques and results

BACKGROUND AND AIMS

Chest-wall contouring surgery is an important part of the gender reassignment process that contributes to strengthening the self-image and facilitating living in the new gender role. Here, we analyze the surgical techniques used in our clinic and report the results.

MATERIAL AND METHODS

Female-to-male transgender patients (n = 57) undergoing chest-wall contouring surgery at Tampere University Hospital between January 2003 and April 2015 were enrolled in the study. Breast appearance was evaluated and either a concentric circular approach or a transverse incision technique was used for mastectomy. Patient characteristics and data regarding the technique and postoperative results were collected and analyzed retrospectively.

RESULTS

In addition to the transgender diagnosis, 40.4% of the patients had another psychiatric diagnosis. For mastectomy, a concentric circular approach was used in 50.9% and a transverse incision approach in 49.1% of the patients. In the transverse incision group, 21.4% of the patients underwent pedicled mammaplasty and 78.6% mastectomy with a free nipple-areola complex graft. Compared with the transverse incision group, breasts were smaller (p < 0.001) and body mass index value was lower in the concentric circular group (p = 0.001). One-third of the patients had complications (hematoma, infection, seroma, fistula, or partial necrosis of nipple-areola complex) and the reoperation rate was 8.8%. Hematoma was the most frequent reason for reoperation. Corrections were required for the scar in 14.0% of the patients, the contour in 28.0%, the areola in 15.8%, and the nipple in 5.3%. Secondary corrections were needed more often in the concentric circular (55.2%) than in the transverse incision group (25.0%; p = 0.031).

CONCLUSIONS

The larger the breast, poorer the skin quality, and greater the amount of excess skin, the longer the required incision and resulting scar is for mastectomy of female-to-male patients. Hematoma is the most common reason for acute reoperation and secondary corrections are often needed.

The effect of adenoidectomy on occlusal development and nasal cavity volume in children with recurrent middle ear infection

OBJECTIVES

The aim of the study was to examine the effect of adenoidectomy on occlusal/dentoalveolar development and nasal cavity volume in children who underwent tympanostomy tube insertion with or without adenoidectomy due to recurrent episodes of middle ear infection.

METHODS

This prospective controlled study consisted of two randomly allocated treatment groups of children, younger than 2 years, who had underwent more than 3-5 events of middle ear infection during the last 6 months or 4-6 events during the last year. At the mean age of 17 months tympanostomy tube placement without adenoidectomy (Group I, n=63) tympanostomy tube placement with adenoidectomy (Group II, n=74) was performed. At the age of 5 years 41 children of the original Group I (14 females, 27 males, mean age 5.2 yrs, SD 0.17) and 59 children of the original Group II (17 females, 42 males, mean age 5.2 yrs, SD 0.18) participated in the re-examination, which included clinical orthodontic examination defining morphological and functional craniofacial status and occlusal bite index to measure upper dental arch dimensions. Acoustic rhinometry and anterior rhinomanometry was made by otorhinolaryngologist at the same day.

RESULTS

No statistically significant differences were found between the groups in the frequencies of morphological or functional characteristics or upper dental arch measurements or in the minimal cross-sectional areas or inspiratory nasal airway resistance measurements.

CONCLUSION

Combining adenoidectomy with tympanostomy tube insertion in the treatment of recurrent middle ear infection at an early age (under the age of 2 years) does not seem to make any difference in occlusal development in primary dentition at the age of 5 years as compared to tympanostomy tube insertion only. Since adenoid size was not evaluated, the findings do not allow interpretation that hypertrophic adenoids should not be removed in children with continuous mouth breathing or sleep disordered breathing.

Specific antibody deficiency in children with recurrent respiratory infections: a controlled study with follow-up

Specific antibody deficiency (SAD) to unconjugated pneumococcal vaccine (PPV) is an established primary B cell immunodeficiency. The occurrence and natural history of SAD in children is unclear. We conducted an observational study to identify SAD in children with recurrent respiratory infections. Ninety-nine children, mean age 5·9 (range 2-16) years, with recurrent or severe infections were vaccinated with PPV; serum antibody concentrations for serotypes 4, 6B, 9V, 14, 18C, 19F and 23F were measured before and 2 weeks after vaccination with enzyme immunoassay. The retrospective control group consisted of 89 healthy children matched for age and gender. No children had received previous conjugated pneumococcal vaccine (PCV) or PPV. The structured history of infectious diseases of all participants was collected. Ten of 91 (11%) children (eight excluded due to immunoglobulin G subclass deficiency) with recurrent respiratory infections had SAD. In the control group, three children (3%) responded inadequately to PPV (P = 0·05). Most children with SAD also had many other minor immune defects. After 0·5-5 years (medium 3·8), eight children with SAD were revaccinated with PPV; five responded adequately and three inadequately. Two SAD children were revaccinated with PCV, one developed an adequate and one an inadequate response. Two children with SAD received treatment with intravenous immunoglobulin; the remaining eight children recovered without replacement therapy during the follow-up. SAD is common in young children with recurrent respiratory infections, but it is often transient and resolves itself within a few years without specific treatment.

A novel mutation W388X underlying properdin deficiency in a Finnish family

Properdin deficiency is a rare immunological disorder inherited as an X-chromosomal recessive trait. Properdin deficiency poses a significant risk for severe meningococcal infections. About 20 mutations have been reported to underlie properdin deficiency. Here we report a large Finnish family with a novel mutation in the properdin gene (CFP). Based on the total absence of properdin activity in a 14-year-old male patient with an infection resembling meningococcal bacteraemia, the coding region and splice sites of the gene were sequenced. The mutation is located in exon 9 and changes guanine to adenine at nucleotide 1164 (c.1164G>A) that causes tryptophan to change to a premature stop codon (W388X). The mother of the patient was shown to be a carrier of the mutation. In total, the mutation was identified in six females and three young males in the family. The mutation must be inherited from the grandfather who had died of an unknown infectious disease. This is the first mutation of the properdin gene identified in Finland.

Preschool asthma after bronchiolitis in infancy

Asthma risk is lower after wheezing associated with respiratory syncytial virus (RSV) than with non-RSV infection in infancy. RSV is the main wheezing-associated virus in infants aged <6 months. We evaluated the outcome of children hospitalised for bronchiolitis at <6 months of age, with special focus on viral aetiology and early risk factors. Out of 205 infants hospitalised for bronchiolitis at <6 months of age, 127 (62%) attended a control visit at a mean age of 6.5 yrs and the parents of an additional 39 children were interviewed by telephone. Thus, follow-up data collected by identical structured questionnaires were available from 166 (81%) children. Viral aetiology of bronchiolitis, studied on admission by antigen detection or PCR, was demonstrable in 97% of cases. Current asthma was present in 21 (12.7%) children: 8.2% in the 110 former RSV patients versus 24% in non-RSV patients (p=0.01). 45 (27%) children had ever had asthma. In adjusted analyses, atopic dermatitis, non-RSV bronchiolitis and maternal asthma were independently significant early-life risk factors for asthma. The risk of asthma was lower after RSV bronchiolitis than after bronchiolitis caused by other viruses in children hospitalised at <6 months of age.

Twelve-month clinical follow-up study of voice patients' recovery using the Voice Activity and Participation Profile (VAPP)

OBJECTIVE

To study the effects of voice treatment including brief voice therapy for 12 months in two groups of voice patients: organic and functional.

DESIGN AND METHODS

A clinical prospective follow-up study with repeated measurements in five phases: medical session, first voice therapy session, last voice therapy session, and 6 months and 12 months after voice therapy. The mean number of voice therapy sessions was 3.4. The main outcome measures were the Voice Activity and Participation Profile (VAPP) and the Symptom Questionnaire. Of consenting patients (n=141) with chronic voice disorders, 46 dropped out during follow-up. Ninety-five patients formed the study group. Forty-one of them received only voice therapy, but the rest of them received combined treatment (medication, amplifiers, and voice massage), but also experienced life events affecting voice. Patients with any laryngeal pathology formed the organic group (n=47), others had a functional voice disorder.

RESULTS

Using the improvement criterion that the change of the VAPP score should exceed standard error of measurement, the percentage of individual patients achieving improvement was 47% in the mild, 59% in the moderate, and 75% in the severe disorder groups. Effect size for VAPP total score was 0.89. The positive effect continued to progress after the therapy ended. Patients with functional or organic voice disorder improved almost equally, although minor findings indicate that functional patients benefited more.

CONCLUSIONS

Voice treatment had a progressive effect for 1 year in half of our patients. No statistical difference was found between the functional and organic patient groups.

Characterisation of patients treated at the Red Cross field hospital in Kashmir during the first three weeks of operation

OBJECTIVE

To evaluate the characteristics of patients treated at a field hospital in the first month after a major earthquake.

METHODS

Age, sex, diagnosis, and operations performed on patients admitted to the field hospital of the International Committee of the Red Cross in Pakistani Kashmir between 21 October and 10 November 2005 were recorded and the data analysed.

RESULTS

During the three week period of this study, 316 patients were treated at the hospital; 246 were women and children (77.9%). Two thirds were hospitalised, over 90% because of the need for surgery or surgical consultation. Altogether 345 operations were performed on 157 patients. The majority of patients had infected wounds with or without fractures.

CONCLUSIONS

Most patients need medical evaluation in consequence of earthquake-related trauma even weeks after the catastrophe, especially in areas difficult of access.

Isolation of enterovirus strains from children with preclinical Type 1 diabetes

AIMS

To develop methods for isolation of enterovirus strains from subjects with preclinical Type 1 diabetes and evaluate if their presence in stools is associated with beta-cell damage.

METHODS

The study subjects were participants of the Finnish Type 1 Diabetes Prediction and Prevention Study (DIPP). The prospectively followed birth cohort comprised 12 children who turned positive for diabetes-associated autoantibodies during the follow-up (case children) and 53 controls matched for date of birth, sex and HLA-DQB1 alleles. Altogether, 878 stool samples were analysed for the presence of enterovirus RNA by RT-PCR followed by virus isolation and partial sequencing of viral genome. Enterovirus antibodies and RNA were simultaneously analysed from serum.

RESULTS

Eleven enterovirus infections were diagnosed in case children and 42 infections in control children by the presence of viral RNA in stools. The proportion of children who were repeatedly enterovirus RNA-positive stools was higher among case than control children (42% vs. 11% of children; P=0.02). Combined serum (antibody and RT-PCR) and stool analyses indicated at least one enterovirus infection in 83% of the case children before the appearance of autoantibodies, while only 42% of the control children had infection by the same age (P=0.006). Twelve enterovirus strains were isolated from case children and 38 strains from control children.

CONCLUSIONS

This protocol makes it possible to isolate a large number of enterovirus strains from prediabetic subjects. The findings suggest that enterovirus infections may be associated with the beta-cell damaging process.

IL-10 gene polymorphism and herpesvirus infections

Genetics has an important role in resistance to various infections and it also may modify the clinical picture of an infectious disease. Here, we briefly review our recent data demonstrating that the polymorphism of the IL-10 gene is associated with resistance to some common herpesviruses and, additionally, that this same gene is involved in the regulation of the severity of the infection and in the reactivation process.

Polymorphism of the interleukin-10 gene is associated with susceptibility to Epstein-Barr virus infection

There are indications that the cytokine interleukin (IL)-10 has a regulatory role in Epstein-Barr virus (EBV)-induced infections. Because the human IL-10 gene demonstrates polymorphism resulting in interindividual differences in cytokine production, the frequencies of the alleles defined by the base exchange polymorphism at the position -1082 (allele 1=G, allele 2=A) were analyzed in EBV-seronegative adults, seropositive adults, and in patients hospitalized because of a severe EBV infection. The frequencies of allele 1 were 0.80, 0.46, and 0.29, respectively. Because this allele is associated with a high IL-10-producing capability, these data suggest that high IL-10 levels protect against EBV infection and, conversely, that low IL-10-producing capability makes individuals more susceptible to a severe EBV infection.

Resistance to human cytomegalovirus infection may be influenced by genetic polymorphisms of the tumour necrosis factor-alpha and interleukin-1 receptor antagonist genes

To examine whether there are genetic differences between cytomegalovirus (CMV)-seronegative and CMV-seropositive adults, the polymorphisms of cytokine genes were analysed in a cohort of 400 adult blood donors. The genes and polymorphic sites studied were the tumour necrosis factor-alpha (TNF-alpha) gene (base exchange polymorphism at position -308; alleles TNF1 and TNF2) and the interleukin-1 receptor antagonist (IL-1RA) gene (variable numbers of 86-bp repeats in intron 2). In this material there were 85 (21%) seronegative persons. The frequencies of the TNF2 and the IL-IRA allele 2 (IL1RN*2) carriers were slightly increased in the seronegative compared with the seropositive samples (39% vs. 29%, and 55% vs. 47%, respectively). The presence of both of these alleles together was significantly (p < 0.05, chi2-test) more frequent in the seronegative population. These data suggest that the alleles of these cytokines, which are known to be associated with a strong inflammatory reaction, may have a protective role against CMV infection.

Polymorphism of the IL-1 gene complex in Epstein-Barr virus seronegative and seropositive adult blood donors

Epstein-Barr virus (EBV) seronegativity is rare in adults. To examine whether genetic differences would explain this, we studied the genetic polymorphisms of the genes of the interleukin-1 (IL-1) complex in seronegative adults. These cytokines (i.e. IL-1alpha, IL-1beta and IL-1 receptor antagonist, IL-1RA) regulate, in several ways, the inflammatory reactions of the body. In each of these genes there are polymorphic sites and the various alleles differ in their frequency in several diseases of inflammatory nature. In 400 healthy blood donors (from 18 to 60 years of age) there were 20 (5%) seronegative persons. The frequency of allele 2 of the IL-1beta gene (base exchange polymorphism at position -511 from the transcriptional start site) was decreased in the seronegative patients (0.20 versus 0.42 in the seropositive patients, P < 0.05, chi2-test). Moreover, the frequency of allele 2 of the IL-1RA (polymorphism defined by variable numbers of 86-bp repeats in intron 2) was slightly, but not significantly, decreased in the seronegative patients. Alleles of these two loci are known to be associated, but in the seronegative patients this association was abnormal: 11 out of 20 (55%) were of the IL-1RA-2 negative/IL-1beta-2 negative type, while of the seropositive patients, 25% were of this type (P < 0.01, chi2-test). These data suggest that immunological differences, depending on cytokine gene polymorphisms, regulate the resistance to EBV infection.

Use of electroporation to construct isogenic mutants of Haemophilus ducreyi

Little is known about the genetics of Haemophilus ducreyi, the etiologic agent of chancroid. To develop a method for constructing isogenic mutants of this organism that could be utilized in pathogenesis-related studies, electroporation techniques were evaluated as a means of introducing DNA into this organism. Electroporation of the plasmid shuttle vector pLS88 into H. ducreyi yielded approximately 10(6) antibiotic-resistant transformants per microgram of plasmid DNA. Studies of the feasibility of moving mutated genes into H. ducreyi were initiated by using NotI linker insertion and mini-Tn10kan mutagenesis techniques to introduce insertion mutations into cloned H. ducreyi genes encoding cell envelope antigens. In the former case, a gene encoding chloramphenicol acetyltransferase was then inserted into the NotI linker site created in the cloned H. ducreyi gene. The recombinant Escherichia coli strains containing these mutated plasmids no longer expressed the homologous H. ducreyi cell envelope antigens, as evidenced by their lack of reactivity with monoclonal antibody probes for these H. ducreyi proteins. Subsequent electroporation of both circular and linearized forms of plasmids carrying these mutated H. ducreyi genes into the homologous wild-type strain of H. ducreyi yielded antibiotic-resistant transformants which also lacked reactivity with the cell envelope antigen-specific monoclonal antibodies. Southern blot analysis confirmed that homologous recombination had occurred in these monoclonal antibody-unreactive transformants, resulting in the replacement of the wild-type allele with the mutated allele. Allelic exchange was most efficient when linear DNA molecules were used for electroporation. These results indicate that electroporation methods can be utilized to construct isogenic mutants of H. ducreyi.

Interleukin-1 production from peripheral blood monocytes in septic infections in children

Interleukin-1 (IL-1) production from peripheral blood mononuclear cells (MNC) was studied in 18 children with septic infection. IL-1 activity was measured from the supernatants of MNC cultures at various times after infection. At the acute stage of infection the IL-1 activity was low (depressed) but rose in early convalescent stage and was normalized at late control after infection. In prolonged infections lasting for 11-25 days the IL-1 activity showed further decline. Rising IL-1 production of MNC in septic infection may be regarded as a good prognostic sign, whereas a declining IL-1 activity may be suggestive of prolonged or complicated course of infection.

Increased interleukin-1 (IL-1) production from LPS-stimulated peripheral blood monocytes in children with febrile convulsions

Peripheral blood mononuclear cells (MNC) from 27 children with a febrile convulsion were tested for production of interleukin-1 (IL-1) in culture. MNC stimulated with lipopolysaccharide (LPS) showed a significantly increased production of IL-1 when compared to MNC from children without convulsions but with bacterial infections (p less than 0.001), viral infections (p less than 0.005) or no infection (p less than 0.005). Children who had experienced a febrile convulsion were retested several months later; this time the IL-1 production from LPS-stimulated MNC was not different from controls. These results demonstrate that MNC at the time of febrile convulsions have increased sensitivity to LPS and possibly to other IL-1 inducers; the resulting enhanced IL-1 response from sensitized MNC may have a role in the pathogenesis of febrile convulsions.

Interleukin-1 production in bacterial meningitis

Interleukin-1 (IL-1) is the key initiator of host responses to infection. We describe here the lipopolysaccharide-(LPS) (20 micrograms/ml) stimulated IL-1 production of peripheral blood monocytes in 2 children with Haemophilus influenzae meningitis. We found a depressed IL-1 production at the acute stage of the infection when the meningitis was most active with return to normal coinciding with clinical recovery. These results show an inverse correlation with acute phase reactants and IL-1 production. Normalization of IL-1 production seems to be a good prognostic sign in bacterial meningitis.

Spontaneous and inducible interleukin 1 production from peripheral blood monocytes in bacterial and viral infections in children

Peripheral blood monocytes from children with severe bacterial infection showed a high level of spontaneous (unstimulated) production of interleukin 1 (IL-1). In viral respiratory or gastrointestinal infections there usually was little or no spontaneous IL-1 production from monocytes, and the values did not differ from those of children with no infections or inflammatory disease. Lipopolysaccharide-induced IL-1 production from monocytes was slightly but not significantly greater in bacterial infections than in viral infections and controls. Tuberculin (purified protein derivative)-induced IL-1 production from monocytes of patients with viral infections was significantly less than in bacterial infections and also slightly less than in controls. These results indicate that systemic bacterial infections activate spontaneous release of IL-1 from monocytes whereas uncomplicated viral infections usually do not. Tuberculin-inducible IL-1 activity of monocytes appears decreased in viral infections; this might be associated with suppressed cell-mediated immunity in such infections.