Slight and short-lasting increase of serum S-100B protein in extra-cranial trauma

OBJECTIVE

Serum S-100B protein is an established biochemical marker of traumatic brain injury. At the same time, the question of extra-cranial S-100B release has been raised. This study evaluates the post-traumatic and post-operative release kinetics of S-100B in 45 trauma victims without head injury.

METHOD

Serum S-100B protein was measured on admission and every 24 hours for 4 consecutive days.

RESULTS

Initial S-100B was slightly increased (median: 0.54 microg L-1) and correlated with the severity of extra-cranial trauma (p = 0.0004, Mann-Whitney test). Both severely (abdominal or chest trauma with or without bone fractures) and mildly (long bone fractures) injured showed a rapid decline of S-100B (< 0.2 microg L-1) around 72 hours post-trauma. Extra-cranial surgery caused a secondary increase of S-100B, especially in the mildly injured group (p = 0.004, Wilcoxon signed rank test).

CONCLUSIONS

Extra-cranial injury results in a mild elevation of serum S-100B protein that declines rapidly (1-3 days after injury).

Adrenal function in non-septic long-stay critically ill patients: evaluation with the low-dose (1 micro g) corticotropin stimulation test

OBJECTIVE

To investigate the adrenal function in non-septic, long-stay critically ill patients.

DESIGN

Prospective, consecutive study.

SETTING

General intensive care unit in a university hospital.

PATIENTS

Forty-three non-septic patients with protracted critical illness.

INTERVENTIONS

A morning blood sample was first obtained to measure baseline plasma cortisol. Subsequently, 1 micro g of corticotropin (ACTH, Synacthene) was injected intravenously and 30 min later a second blood sample was drawn to determine stimulated plasma cortisol. Patients having a stimulated cortisol level of at least 18 micro g/dl were defined as responders. In 36 patients, morning interleukin-6 (IL-6) was also measured.

MEASUREMENTS AND RESULTS

Baseline and stimulated plasma cortisol were 16.8+/-4.1 micro g/dl and 21.2+/-5.1 micro g/dl, respectively. Interleukin-6 was high (median 39.3 pg/ml, interquartile range 24.9-86.6 pg/ml) and correlated negatively with stimulated plasma cortisol (r=-0.40, p<0.05). Of the 43 patients studied, 31 patients (72%) were responders and 12 patients (28%) were non-responders to the ACTH stimulation test. Overall, 18 patients died and 25 patients survived to hospital discharge. Non-responders had significantly higher IL-6 levels compared to responders (106+/-73 versus 48+/-42 pg/ml, p<0.05), whereas mortality rate was comparable in the two groups (50% versus 38%, p=0.74).

CONCLUSIONS

Circulating plasma IL-6 levels are high during protracted critical illness, and are partially responsible for the relative adrenal insufficiency found in a subset of severely ill patients.

Bile canaliculi are defective in hepatic involvement of organ failure and recovery of liver function is due to their secondary regeneration

OBJECTIVE

To investigate the morphological changes in the liver in patients with organ failure and hyperbilirubinemia and to correlate them to the outcome.

DESIGN

A case series prospective study.

SETTING

Intensive care units of two general hospitals.

PATIENTS

Twelve patients in organ failure with predominant hepatic involvement, aged 16 to 69 years (mean 56 years).

INTERVENTIONS

Liver biopsy was performed on all patients 3-15 days after organ failure. A second biopsy was also performed on all four surviving patients, as well as on 3 patients just before death at a mean time of 16 days (6-32) and 31 days (14-55), respectively, after the first biopsy. The samples were studied by electron microscopy and findings were assessed according to Rappaport's designation.

MEASUREMENTS AND MAIN RESULTS

In the first biopsy it was shown that in zone III there was complete degeneration of bile canaliculi and hepatocytes in contrast to zone I. The grade of histological severity for zone III is positively correlated to the bilirubin concentration (p = 0.001). In the specimens from the second biopsy, it was shown that numerous, newly formed secondary bile canaliculi per 20 consecutive hepatocytes had developed in zone III in the surviving patients, whereas there was a complete absence of such canaliculi in the patients who died (mean +/- SD: 9.6 +/- 3.2 vs 0).

CONCLUSIONS

It appears that the destruction of primary bile canaliculi is a striking anatomical defect in patients with organ failure and impaired bilirubin excretion. The restoration of liver function coincides with adequate formation of new secondary bile canaliculi in zone III, giving credence to the hypothesis that this formation is an important structural change responsible for the improvement in liver function.