Segmental spinal dysgenesis: a report of early surgical intervention and outcome in a 14-month-old child

Segmental spinal dysgenesis is a rare spinal deformity that is the result of failure of formation resulting in some cases spondyloptosis and neurological dysfunction usually at the thoracolumbar junction. There is little known concerning surgical intervention and timing in these patients. The goal of this case report is to present a case involving 14 months old diagnosed with segmental spinal dysgenesis with stenosis at the thoracolumbar junction soon after birth, treated with definitive posterior spinal fusion and subsequent follow-up.

A review of the amyloidoses that infiltrate the heart

Primary amyloidosis, systemic senile amyloidosis, isolated atrial amyloidosis, and transthyretin isoleucine 122 amyloidosis frequently involve the heart. Amyloid fibrils infiltrate the myocardium, impairing ventricular contraction and relaxation. The clinical manifestations of cardiac infiltration in these disorders are protean, though congestive heart failure and arrhythmias are most common. Treatment of cardiac amyloidosis is directed at the underlying cause and at relief of symptoms. Heart transplantation is not a viable treatment option for patients with primary amyloidosis; its role in the other amyloidoses has not been established. The prognosis of patients with cardiac amyloidosis varies and is largely determined by the underlying disorder responsible for amyloid infiltration.

Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis

BACKGROUND

Lymphocytic myocarditis causes left ventricular dysfunction that may be persistent or reversible. There are no clinical criteria that predict which patients will recover ventricular function and which cases will progress to dilated cardiomyopathy. We hypothesized that patients with fulminant myocarditis may have a better long-term prognosis than those with acute (nonfulminant) myocarditis.

METHODS

We identified 147 patients considered to have myocarditis according to the findings on endomyocardial biopsy and the Dallas histopathological criteria. Fulminant myocarditis was diagnosed on the basis of clinical features at presentation, including the presence of severe hemodynamic compromise, rapid onset of symptoms, and fever. Patients with acute myocarditis did not have these features. The incidence of the end point of this study, death or heart transplantation, was ascertained by contact with the patient or the patient's family or by a search of the National Death Index. The average period of follow-up was 5.6 years.

RESULTS

A total of 15 patients met the criteria for fulminant myocarditis, and 132 met the criteria for acute myocarditis. Among the patients with fulminant myocarditis, 93 percent were alive without having received a heart transplant 11 years after biopsy (95 percent confidence interval, 59 to 99 percent), as compared with only 45 percent of those with acute myocarditis (95 percent confidence interval, 30 to 58 percent; P=0.05 by the log-rank test). Fulminant myocarditis was an independent predictor of survival after adjustments were made for age, histopathological findings, and hemodynamic variables. The rate of transplantation-free survival did not differ significantly between the patients considered to have borderline myocarditis and those considered to have active myocarditis according to the Dallas histopathological criteria.

CONCLUSIONS

Fulminant myocarditis is a distinct clinical entity with an excellent long-term prognosis. Aggressive hemodynamic support is warranted for patients with this condition.

Management of neuromuscular scoliosis

Neuromuscular scoliosis is classified as a neuropathic or myopathic type. Cerebral palsy is the most common form of neuropathic type, and Duchenne's muscular dystrophy best characterizes the principles and recommended treatment for the myopathic type. Nonoperative measures rarely fully control a progressive scoliosis. Careful preoperative planning and surgery can achieve a well-balanced spine over a level pelvis with a good functional result.

S rod fixation to the sacrum in patients with neuromuscular spinal deformities

A new form of pelvic fixation has been designed for use in patients with neuromuscular spinal deformities to overcome the problems imposed by the Galveston technique. One end of a Luque rod is prebent into an S shaped configuration and placed over the sacral ala supplying firm fixation across the lumbosacral junction without crossing the sacroiliac joint. It fixes firmly against the sacral ala by distracting against a hook or screw in the lumbar spine. A 12 year retrospective review of 67 patients with severe neuromuscular spinal deformities was accomplished. All surgeries were performed by one surgeon. All patients had good deformity correction with an average followup of 6 years and 2 months. Complications included: recurrence of pelvic obliquity (one patient), skin break-down over hardware (one patient), migration of hardware at sacrum (two patients), and rod breakage (five patients). The S rod is recommended for all patients with neuromuscular spinal deformities who require instrument fixation to the pelvis. Its ease of insertion and decreased operative time allow for a safe and dependable alternative fixation to the sacrum without crossing the sacroiliac joint.

Back pain in childhood and adolescence

A variety of disorders can account for back pain in the child or adolescent (Outline 1). Some of these can result in significant morbidity if not properly diagnosed and treated. Fortunately, nearly all can be correctly diagnosed by taking a thorough medical history, performing a complete physical examination, and obtaining appropriate imaging and laboratory studies. Although back pain in children and adolescents may result from overuse or minor trauma and will respond to rest and anti-inflammatories, this review should enable the orthopaedist to systematically recognize those back disorders in need of more aggressive medical intervention.

Atypical mycobacterial vertebral osteomyelitis in a steroid-dependent adolescent. A case report

Atypical mycobacterial infections are uncommon, particularly in the spine. The authors present the case of a patient with vertebral osteomyelitis secondary to Mycobacterium chelonae subspecies abscessus that was successfully treated with surgical debridement and stabilization, followed by chemotherapy.

The use of total circulatory arrest in the surgery of giant hemangioma and Klippel-Trenaunay syndrome in neonates

Two neonates required deep hypothermia and circulatory arrest to provide a central control of blood loss for the resection of giant cavernous hemangiomas. Both infants were placed on cardiopulmonary bypass, cooled to 16 degrees, and exsanguinated before resection of these peripheral lesions. The surgery was done as a lifesaving measure in both instances because both infants were suffering from high-output cardiac failure. In both cases, the small total blood volumes were critical in excision of these hypervascular tumors. Use of the techniques described allowed for the surgery to be performed in a bloodless field over a short period (one hour), thus preventing massive blood loss. Both patients are living with no neurologic or developmental deficits more than five years after the operation.

Air embolism in spinal surgery

We present two cases of fatal venous air embolism that occurred in previously healthy adolescents during posterior spine fusion and instrumentation for scoliosis. Previously recorded cases in the literature have been rare and only briefly discussed. Air embolism has been a complication noted in the anesthesia and neurosurgical literature, occurring primarily in total hip patients and those patients undergoing neurosurgical procedures in a sitting position. An examination of the pathophysiology of air embolism in posterior spinal procedures would indicate the use of properly placed central lines and end-expiratory CO2 monitoring as the primary modes of detection and treatment considering the potentially fatal risk factors for spinal patients.

Pseudomonas osteochondritis complicating puncture wounds of the foot in children: a 10-year evaluation

From 1978 to 1988, microbiologically proven Pseudomonas osteochondritis and septic arthritis following nail puncture wound to the foot was diagnosed in 77 children aged 18 mo-19 y (77 and 17 cases, respectively). The syndromes were found in children with a history of wearing tennis shoes (70 cases), other shoes (5), and no shoes (2). All cases had surgical debridement of the infected cartilage or bone and drainage of infected joints. Pseudomonas aeruginosa was isolated in 38 cases and in conjunction with Staphylococcus aureus in 18. Anti-Pseudomonas antibiotics were initiated in all cases before surgical exploration; the average duration of treatment was 7.5 +/- 1.2 d postoperatively. Patient follow-up was 5.2 +/- 3.4 y (median, 4.8 y; range, 3 mo-10 y). Two relapses occurred; both patients had a previously undetected septic arthritis. These data suggest that with aggressive surgical management, Pseudomonas osteochondritis and septic arthritis can be treated effectively with postoperative antibiotics for 7 d.

Luque fixation to the sacral ala using the Dunn-McCarthy modification

The Galveston-Luque technique of fixation to the pelvis requires solid bone and a strong pelvis. Because the majority of neuromuscular patients who require fixation to the pelvis have a weak and thin illum, an alternative to the Galveston technique was sought. A technique of rod contouring was developed that takes advantage of the reliable, stout bone of the sacral ala for fixation. Twenty-four patients have been instrumented with Luque rods and fused to the sacrum over the past 4 years using the technique. There have been no complications in this short follow-up.

Altered gentamicin disposition in a child with a cavernous hemangioma

Physiologic third spacing can cause an increase in the volume of distribution of certain drugs, such as aminoglycosides, which results in a decrease in the serum concentration. The case reported here, that of a child with a large cavernous hemangioma, demonstrated this phenomenon. To obtain adequate serum and tissue concentrations, alteration of antimicrobial dosing may be needed in similar cases.

Discoid lateral meniscus in a young child: case report and review of the literature

Management of discoid lateral meniscus in a 6-month-old child is discussed. The patient presented with a lateral knee mass and an associated popping sound of the joint during flexion and extension. The diagnosis, which the authors believe to be the youngest presentation of this entity, was confirmed by arthrography. Computed tomographic features and magnetic resonance images of the discoid meniscus are presented. Management and theories of etiology of the discoid lateral meniscus are discussed.

Proximal femoral resection to allow adults who have severe cerebral palsy to sit

Resection of the proximal end of the femur and interpositional arthroplasty was done in thirty-four patients (fifty-six hips) to allow the patients to sit comfortably and to make perineal care painless. All of the patients were severely handicapped because of cerebral palsy, were unable to walk, and were residents of one of two state institutions. After a minimum follow-up of two years, the result had not deteriorated in thirty-three of the thirty-four patients.

Importance of mucopolysaccharides as substrates for Bacteroides thetaiotaomicron growing in intestinal tracts of exgermfree mice

We used two approaches to determine whether the mucopolysaccharide chondroitin sulfate is an important source of carbon and energy for Bacteroides thetaiotaomicron in the intestinal tracts of germfree mice. First, we tested the ability of three mutants that grew poorly or not at all on chondroitin sulfate to colonize the intestinal tract of a germfree mouse and to compete with wild-type B. thetaiotaomicron in this model system. One mutant (CG10) was rapidly outcompeted by the wild type. However, since this mutant was unable to grow on chondroitin sulfate because it could not grow on N-acetyl-galactosamine, one of its monosaccharide components, this mutant might also be unable to utilize glycoprotein mucins. Two mutants (46-1 and 46-4) were isolated that grew poorly on chondroitin sulfate but normally on both component sugars. One of them was outcompeted by the wild type, but the percent wild type increased more slowly than with CG10. In one experiment, the percent wild type never reached 100%. The other (46-4) was not outcompeted by the wild type. These results indicate that, although chondroitin sulfate may be a carbon source in the animal, it is not of major importance. Our second approach was to determine by immunoblot analysis whether a 28-kilodalton outer membrane protein that is produced by B. thetaiotaomicron only when it is grown on chondroitin sulfate or hyaluronic acid was being produced at induced level by B. thetaiotaomicron growing in the ceca of exgermfree mice. There was no evidence for induction of this protein in vivo. Thus, the immunoblot results are consistent with results of the mutant competition experiments.

Role of starch as a substrate for Bacteroides vulgatus growing in the human colon

Bacteroides vulgatus is the numerically predominant Bacteroides species in the human colonic microflora. Unlike other colonic Bacteroides species, B. vulgatus is not a versatile utilizer of polysaccharides. The only types of polysaccharide that support rapid growth and high growth yields by all strains are the starches amylose and amylopectin. Amylase and alpha-glucosidase activities are among the highest found in a bacterial fraction obtained from human feces. This observation raised the question of whether B. vulgatus was the source of the fecal enzymes. Both alpha-glucosidase and amylase were produced at 20- to 40-fold-higher levels when B. vulgatus was grown on maltose, amylose, or amylopectin than when B. vulgatus was grown on glucose or other monosaccharides. Both enzymes had the same pI (4.6 to 5.0) and undenatured molecular weight (150,000). The pIs and molecular weights of the B. vulgatus amylase and alpha-glucosidase were the same as those of the fecal enzymes. To determine whether the B. vulgatus alpha-glucosidase was identical to the fecal alpha-glucosidase, we partially purified the B. vulgatus enzyme and raised an antiserum against it. Using this antiserum, we showed that all strains of B. vulgatus produced the same enzyme. The antiserum did not detect the B. vulgatus alpha-glucosidase in the bacterial fraction from human feces, even when a partially purified preparation of the fecal enzyme was used. Thus the alpha-glucosidase activity in the bacterial fraction from human feces is not the B. vulgatus enzyme.

Tumoral calcinosis in a child

Tumoral calcinosis is a rare benign tumor found adjacent to large joints, restricting motion and sometimes eroding through the skin. We report a case of this disease in a 9-month-old treated with surgical excision.

A locking collar for Luque rods

The migration of hardware has been a problem in the Luque system of segmental spinal instrumentation. To prevent this migration, a device was designed to slip on the 3/16th inch or 1/4 inch Luque rod. This prevents movement between the wire-rod interface, stopping both distal and proximal rotation of the rod. This article reports 21 patients with neuromuscular scoliosis on whom this technique was used. There was no migration of hardware and only one wire breakage in an area separate from the locking collar. These results are a marked improvement from patients of previous reports who did not receive the new device. Laboratory testing on the locking collar determined the best location on the "L" rod to be in the middle third of the rod. Rod migration has essentially been eliminated with this technique.

Simultaneous bilateral avulsion fracture of the tibial tuberosity. A case report

Bilateral avulsion fracture of the tibial tuberosity is a rare injury. A 14-year-old male gymnast sustained simultaneous tibial tuberosity displaced fractures while attempting a forward flip. The recommended treatment was open reduction and internal fixation. Functional results were excellent one year after surgical treatment.

Prevention of the complications of scoliosis by early detection

The focus of medicine has increasingly turned toward prevention rather than treatment of disease. In the absence of the ability to prevent the occurrence of scoliosis, the focus of attention should be on early identification in order to prevent complications brought on by the disease. Scoliosis detection through screening of school children is a technique that has been popularized over the last three decades. The screening technique can be performed by trained personnel. Though the initial result of these screenings was over-diagnosis, the program has been shown to be cost-effective when the screeners are well-trained and appropriate referrals are made to minimize the lack of specificity. The use of the scoliometer to make a quantitative determination of the degree of truncal rotation has reduced the number of inappropriate referrals. The complications of scoliosis itself include pulmonary compromise, pain, and deformity; these are best prevented by early detection and early treatment. When scoliosis is treated late and larger curves are present, more involved and complication-ridden procedures are required. School children screening programs promote a better understanding and heightened awareness of this disease and acceptance of the treatment methods by the public.

Evidence that polygalacturonic acid may not be a major source of carbon and energy for some colonic Bacteroides species

Five Bacteroides species that are found in the human colon can utilize polygalacturonic acid (PGA) when they are grown in laboratory media: Bacteroides thetaiotaomicron, Bacteroides vulgatus, Bacteroides ovatus, Bacteroides fragilis subsp. a, and Bacteroides sp. strain 3452A (an unnamed DNA-DNA homology group). PGA-degrading enzymes from B. thetaiotaomicron have been isolated and characterized previously. To determine whether a PGA lyase activity in human feces could be attributed to any of these species, we first determined the properties of PGA lyases from the other four Bacteroides species. PGA lyases from all the Bacteroides species were soluble, cell associated, and inducible by PGA. All had similar pH optima (8.4 to 8.8) and similar molecular weights (50,000). All activities were enhanced by calcium. The PGA lyases from the five species differed with respect to isoelectric point: B. thetaiotaomicron (pI 7.5), B. vulgatus (pI 7.7), B. ovatus (pI 5.8, 7.2), B. fragilis subsp. a (pI 6.1), and Bacteroides sp. strain 3452A (pI 7.7). The PGA lyase activity in human feces resembled those of the Bacteroides PGA lyases in that it had a pH optimum of 8.4 to 8.8 and was enhanced by calcium. However, it differed from the Bacteroides PGA lyases both with respect to isoelectric point (pI 4.2 to 4.4) and molecular weight (100,000). On the basis of these findings, it appears that the PGA lyase activity in human feces is not produced by any of the Bacteroides species surveyed in this survey. Moreover, there was no detectable PGA lyase activity in feces that had the same properties as the Bacteroides enzymes.(ABSTRACT TRUNCATED AT 250 WORDS)

Bilateral fracture of the pedicle of the second cervical vertebra in the young child

We report the cases of five children, six to eighteen months old, who had bilateral fracture of the pedicles of the second cervical vertebra. The children were treated with gentle cervical traction in mild extension or were maintained in near-anatomical reduction in a Minerva jacket or halo cast. The fractures united in four patients. One patient underwent fusion to stabilize the spine.

Allograft bone in spinal fusion for paralytic scoliosis

To determine the efficacy of allograft bone in spinal surgery, a retrospective study was carried out on thirty-two patients who had had spinal fusion with banked bone from the femoral head between 1977 and 1983. The diagnoses were paralytic and neuromuscular scoliosis. At final follow-up (average, 3.7 years), the infection rate was 9.3 per cent. There were no pseudarthroses, and all patients had well marginated trabecular markings by eighteen months. The rates of complications and of fusion were comparable with or better than those obtained using autogenous bone graft.

A method for early spica cast application in treatment of pediatric femoral shaft fractures

A method is described for early spica cast application in treatment of pediatric femoral shaft fractures whereby the variables are reduced and the cast is applied in stages. The fracture reduction is carefully planned, and molds are checked before final casting.

Acquired bone dysplasia secondary to catheter-related complications in the neonate

Four neonates presented with leg-length discrepancy in the first and second year of life, secondary to physeal growth arrest. All four had stormy postnatal periods, requiring indwelling arterial and/or hyperalimentation catheters. One had documented osteomyelitis. In the last three cases, the growth disturbance may have been secondary to aseptic emboli to the bones from the indwelling catheters. In two cases, there was evidence of other nonseptic embolic phenomena.

Timentin therapy for bone, joint, and deep soft tissue infections in children

Timentin, a combination of clavulanic acid (0.1 g) and ticarcillin (3.0 g), has proved effective in vitro against bacterial pathogens that produce beta-lactamases. The usual etiologic bacteria of osteochondritis of the foot (Pseudomonas species) and osteomyelitis/septic arthritis (Staphylococcus aureus) are commonly resistant to penicillins. To date, we have used Timentin to treat 30 children with bone, joint, and deep soft tissue infections. Timentin was administered intravenously at an average dosage of 207 mg/kg per day for mild to moderate infection and 310 mg/kg per day for bone and joint infections with systemic signs (sepsis). The lower dose was used in 24 patients and the other six patients, who had signs of sepsis, received the higher dose. All patients received Timentin intravenously over 30 minutes every four to six hours for a minimum of five days (mean 6.6 +/- 2.6 days, range five to 14 days). The mean time to defervescence and/or reduction in clinical symptoms was 1.6 +/- 1.3 days (range zero to four days). Osteochondritis due to P. aeruginosa was diagnosed in six patients, and septic bursitis, osteomyelitis, or septic arthritis due to S. aureus (13 patients) or Staphylococcus species and group A streptococci (four patients) was diagnosed in 17 patients. All isolates were susceptible to Timentin in vitro by disk-diffusion analysis. All patients showed a response to therapy with Timentin, with or without surgical intervention. All patients had clinical and microbiologic cures; no adverse reactions or side effects were observed. There have been no clinical or microbiologic relapses to date. Timentin may prove to be useful in specific bone and joint infections in children.

Location and characteristics of enzymes involved in the breakdown of polygalacturonic acid by Bacteroides thetaiotaomicron

When Bacteroides thetaiotaomicron is grown in medium which contains polygalacturonic acid (PGA) as the sole carbon source, two different polygalacturonases are produced: a PGA lyase (EC 4.2.2.2) and a PGA hydrolase (EC 3.2.1.15). Both enzymes are cell associated. The PGA hydrolase appears to be an inner membrane protein. The PGA lyase is a soluble protein that associates with membranes under certain conditions. The PGA lyase was purified to apparent homogeneity. It has a molecular weight (from sodium dodecyl sulfate-polyacrylamide gel electrophoresis) of 74,000, a pH optimum of 8.7, a pI of 7.5, and a Km for PGA of 40 to 70 micrograms/ml. It requires calcium for maximal activity. The main product of this enzyme appears to be a disaccharide that contains a delta 4,5-unsaturated galacturonic acid residue. The PGA hydrolase can be solubilized from membranes with 2% Triton X-100 and has been partially purified. It has a pH optimum of 5.4 to 5.5, a pI of 4.7 to 4.9, and a Km for PGA of 350 to 400 micrograms/ml. The main product of this enzyme appears to be galacturonic acid. The specific activities of both PGA hydrolase and PGA lyase increase at the same rate when bacteria are exposed to PGA. The two enzymes therefore appear to be similarly regulated.

Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications

This retrospective analysis of 406 patients with proximal femoral fractures was designed to identify both the significant and nonsignificant risk factors that influence patient mortality. The 399 patients treated by open reduction and internal fixation or femoral head prostheses routinely received prophylactic antibiotics and anticoagulants. Of 406 patients followed until death or for at least one year, the overall mortality rate at one year was 14% (58/406). For patients with subcapital fractures the rate was 13% (25/187) and with intertrochanteric fractures 15% (33/219). The expected mortality rate for the normal population of similar age was about 9%. Sex, treatment of subcapital fracture by either internal fixation or arthroplasty, and the level of postoperative ambulation did not influence mortality. The number of preexisting medical conditions and the time of surgery following admission were highly significant factors (p less than or equal to 0.001 for both). The number of postoperative medical complications was also significant. The recommendation is for serious medical conditions to be maximally stabilized for at least 24 hours and pulmonary and physical therapy instituted before scheduling open surgical procedures.

Early casting of femoral shaft fractures in children

Twenty-six children with fractures of the femur were entered into a prospective study to determine the efficacy of treating certain of these fractures by early spica cast immobilization. They were compared with 50 consecutive patients with similar fractures who were treated prior to the study to determine the potential cost savings and decrease in patient days in hospital. The clinical results of treatment were compared with results from the literature and the previous group where applicable. Our conclusion from this study is that most femoral shaft fractures in children under 10 years of age can be treated by closed reduction and early spica cast immobilization with results that are at least as good as those achieved by conventional methods, and with a 70% savings in hospital cost. Factors such as obesity, swelling, shortening, comminution, and fracture type can all combine to give relative contraindications for the use of this technique.

Amputation for congenital pseudarthrosis of the tibia. Indications and techniques

The indications for amputation with pseudarthrosis of the tibia are: failure of bony union after three surgical attempts; significant leg-length discrepancy; interference with growth distal to the pseudarthrosis; and a significant period under medical care, such that the patient suffers unduly. The primary problems related to amputating at the level of the pseudarthrosis are poor stump configuration, bony overgrowth, and poor skin coverage. A distal amputation at the ankle is recommended, using the technique for a cartilage-preserving Symes amputation. Methods for realigning the tibia at the time of amputation include the use of an intermedullary rod or a compression plate. The ultimate goal of treatment is always a functional limb.

Anomalous volar branch of the dorsal cutaneous ulnar nerve: a case report

A 17-year-old boy, who had complained of pain for many years, had an anomalous branch from the dorsal ulnar cutaneous nerve which passed ulnar to the pisiform bone and was compressed by the flexor carpi ulnaris tendon. The symptoms were relieved completely by decompression of this nerve.

Simultaneous stimulation and suppression of two different indicators of the cell-mediated immune response by the immunoregulator dextran sulphate

The effect of high mol. wt dextran sulphate (DS) on two different indicators of the cell-mediated immune response was studied simultaneously in the same animal. The two indicators of the cell-meidated immune response chosen for this study were the footpad swelling response to sheep red blood cells (SRBC) and skin allograft rejection. Mice receiving DS and SRBC showed a significant increase in the delayed-type footpad swelling response over the controls at 24 and 48 h after challenge, while in addition, the same mice showed a significant suppression of the delayed-type response to allograft antigens as indicated by a significant delay in rejection time of allografts. The results presented here show that DS is capable of simultaneously stimulating and suppressing two indicators of the cell-mediated immune response in the same animal.

Suppression of cell-mediated immune responses by dextran sulphate

The effect of high molecular weight dextran sulphate (DS) on cell-mediated immune responses was studied. Two criteria were used to assess cell-mediated responses, skin graft rejection and intra-dermal (i.d.) skin tests. Mice receiving allografts and DS displayed a significant increase in graft survival time compared with untreated control animals. Similar results were obtained when the grafted animals differed at only the H-Y locus. Guinea-pigs sensitized with Mycobacterium tuberculosis and treated with DS showed a greatly reduced delayed skin test response when challenged with purified protein derivative. DS was capable of suppressing this response even though, by the same route, dosage, and time of administration, it was previously shown to enhance a cell-mediated response in guinea-pigs sensitized with a different antigen. The results of this study indicate that the adjuvant DS is capable of suppressing cell-mediated immune responses in mice and guinea-pigs.

Dextran sulphate: an adjuvant for cell-mediated immune responses

The effect of high mol. wt dextran sulphate (DS) on cell-mediated immune responses was studied. Three criteria were used to assess cell-mediated delayed-type hypersensitivity: footpad swelling, i.d. skin tests and macrophage migration inhibitory factor (MIF) production. Guinea-pigs sensitized with egg albumin (EA) and treated with DS showed strong positive delayed skin tests. Control animals given only EA showed negative skin tests. Lymphocytes from mice sensitized s.c. with EA and treated with DS showed an increase in MIF production. Delayed footpad swelling responses in mice sensitized s.c. with sheep red blood cells (SRBC) and treated with DS were increased when the mice were challenged 8 days after sensitization. Doses of DS which were effective in increasing delayed footpad swelling ranged from 50-200 mg DS/kg body weight. DS was only capable of increasing delayed footpad swelling responses when both SRBC and DS were injected s.c. at the same site. Intraperitoneal injection of both SRBC and DS obeebction of both s.c. but at different sites did not result in increased delayed footpad swelling. DS was capable of augmenting footpad swelling responses when given s.c. as much as 6 days before SRBC. The optimal time for administration of DS was 2 days before SRBC. Injection of DS 2 days or more after SRBC resulted in no increase in delayed footpad swelling responses. The results of this study indicate that dextran sulphate is a potent adjuvant for cell-mediated delayed-type hypersensitivity immune responses in both mice and guinea-pigs.