1/45. Assessment of immunological status in the critically ill.The systemic inflammatory response (SIRS) results from various types of injuries such as severe infection, trauma, ischemia-reperfusion and major surgery including cardiac surgery with cardio-pulmonary bypass. This response involves immune cell activation and a complex network of proinflammatory cytokines, which may induce multiple organ failure when uncontrolled. The monocyte plsys a central role in the response to infection with the release of TNF-alpha, IL-1 beta, and IL-12. In addition, monocytes present antigens to T lymphocytes. An optimal antigen presentation requires the expression of MHC class II HLA-DR on monocytes surface and of costimulatory molecules such as CD54 on monocytes and LFA-1 on lymphocytes. It has become increasingly apparent that the proinflammatory response is balanced by concomitant anti-inflammatory mechanisms that results in monocyte deactivation, characterized by a decrease in HLA-DR expression and the release of anti-inflammatory cytokines such as IL-10. This counterregulatory response, if prolonged or predominant, may predispose the patient to a higher risk of infection. Further studies need to be conducted to precise: i) the intensity of depression of the surface molocule expression assessing monocyte function, such as HLA DR and CD54; ii) the level of IL-10 and IL-12 release in patients with severe sepsis; iii) the immuno-modulating effects of frequently used treatments in these patients with severe sepsis and in surgical patients; iv) the time course of recovery; v) if the monitoring of HLA-DR, CD54, IL-10 and IL-12 will better predict the clinical outcome than clinical parameters.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
2/45. Second allogeneic peripheral blood stem cell transplantation with fludarabine-based low-intensity conditioning regimen for relapsed myelodysplastic syndrome after allogeneic bone marrow transplantation.We describe the case of a 51-year-old patient with relapsed myelodysplastic syndrome after allogeneic bone marrow transplantation (BMT), who underwent allogeneic peripheral blood stem cell transplantation (PBSCT) after conditioning with a novel regimen consisting of fludarabine, busulfan, and antithymocyte globulin. The second PBSCT was performed early, at 3 months after the initial allogeneic BMT, but it was well tolerated and complete hematologic remission was documented. The patient did not experience any early transplantation-related organ toxicity but died from opportunistic infection 6 months after the second transplantation. Our experience suggests that this novel regimen may induce remission and could be offered to patients relapsing after the first transplantation; however, the fludarabine-containing regimen might be accompanied by profound immunosuppression.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
3/45. Bilateral abducens nerve paresis associated with anti-GQ1b IgG antibody.PURPOSE: To describe two cases with bilateral abducens nerve paresis associated with serum anti-GQ1b IgG antibody. methods: case reports. RESULTS: Two boys, aged 12 and 10 years, experienced acute onset of diplopia after preceding symptoms and signs of infection. In both boys, examination showed only bilateral abducens nerve paresis. Although routine laboratory data and magnetic resonance imaging demonstrated no pathologic findings, titer of anti-GQ1b IgG antibody in the sera of both patients was increased. diplopia and signs of bilateral abducens nerve paresis disappeared in 6 weeks without any specific treatment. CONCLUSION: The anti-GQ1b IgG antibody in the sera of both patients probably contributed to the bilateral abducens nerve paresis.- - - - - - - - - - ranking = 2.350485652099keywords = nerve (Clic here for more details about this article) |
4/45. Experience with Morgan perfusion contact lens in treating eye infections and burns.The effects of a new therapeutic perfusion contact lens upon heavy infections and severe burns had been observed in 30 cases. We conclude that this method is advantageous, where there is a shortage of nursing personnel. We also consider the advisability of instructing sick bay attendants in large factories and military personnel in the use of the contact lens in order to bridge the critical phase between injury and hospital treatment.- - - - - - - - - - ranking = 4keywords = organ (Clic here for more details about this article) |
5/45. Infection-related atlantoaxial subluxation in two adults: Grisel syndrome or not?Grisel's syndrome involves the subluxation of the atlanto-axial joint from inflammatory ligamantous laxity following an infectious process in the head or neck. It is a rare disease usually affecting children, but infrequent adult cases do occur. Today, due to the widened use of antibiotics and availability of MR imaging, some cases presenting with neck pain, resulting from the infectious inflammation of C1 and C2 but without pronounced subluxation, can be a challenging problem for most neurosurgeons. Several theories have been proposed to explain the pathogenesis of inflammatory subluxation. The primary treatment of Grisel's syndrome is medical. The underlying infectious organism must be isolated and appropriate antibiotics must be prescribed. The subluxation is reduced in holter or skeletal traction. This paper reports two cases of infection-related atlanto-axial subluxation in two adults. The literature on this subject is briefly reviewed.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
6/45. Longitudinal changes of anti-ganglioside antibodies before and after guillain-barre syndrome onset subsequent to campylobacter jejuni enteritis.Anti-ganglioside antibodies frequently are present in sera from patients with guillain-barre syndrome (GBS) during the acute phase, but no patients in whom anti-ganglioside antibodies were tested before the onset of the syndrome have been reported. We describe the first case of GBS subsequent to campylobacter jejuni infection, in which longitudinal changes in anti-ganglioside antibody titers were measured before and after the onset of limb weakness. serum antibody titers against GM1 (IgM/IgG), GM1b (IgM/IgG), GalNAc-GD1a (IgM/IgG), and GD1b (IgG) were highest on the day of onset, but negative before onset. Anti-C. jejuni IgG and IgA antibody titers paralleled those of the anti-ganglioside antibodies, indicative that C. jejuni infection triggered anti-ganglioside antibody production. Press et al. [J. Neurol. Sci. 190 (2001) 41] reported that anti-ganglioside antibody titers peaked during the recovery phase, but our findings are counter to theirs. We speculate that anti-ganglioside antibodies are the primary effectors of nerve damage in GBS.- - - - - - - - - - ranking = 0.29381070651237keywords = nerve (Clic here for more details about this article) |
7/45. Ischemic glans penis after circumcision.A 33-year-old male receiving dorsal penile nerve block (DPNB) for circumcision exhibited a postoperative ischemic change over the glans penis. The event occurred nearly 24 hours after the procedure. The patient was treated with intravenous pentoxifyllin and hyperbaric oxygenation. Total reverse of the ischemia was observed. The complications associated with circumcision and DPNB were reviewed and discussed.- - - - - - - - - - ranking = 0.29381070651237keywords = nerve (Clic here for more details about this article) |
8/45. Infection with human herpesvirus 6 after kidney-pancreas transplant.We describe the first known case of symptomatic infection resulting from human herpesvirus-6 (HHV-6) in simultaneous pancreas-kidney transplant recipients. The role of HHV-6 in solid-organ transplant recipients is not well defined. In hematopoietic stem cell transplantation (SCT) HHV-6 may cause fever, rash, myelosuppression, interstitial pneumonitis, and encephalitis.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
9/45. Thermal tissue damage caused by ultrasonic cement removal from the humerus.BACKGROUND: Ultrasound devices can selectively remove cement during revision arthroplasty. These instruments initially were designed for the hip and knee but also have been applied to the upper extremity. We describe a patient in whom a radial nerve palsy and a pathologic humeral fracture developed after ultrasonic cement removal was performed because of an infection at the site of a total elbow arthroplasty. Biopsies of the humerus, the triceps muscle, and the radial nerve showed widespread necrosis consistent with thermal injury. methods: A study involving six human cadaveric specimens was conducted to measure temperature elevations in bone and adjacent soft tissue during cement removal with use of an ultrasound device with and without irrigation. RESULTS: While temperature increased only minimally during cement polymerization, ultrasonic melting and removal of cement with use of constant energy delivery led to markedly elevated temperatures in the humeral cortex, the triceps muscle, and the radial nerve. These temperatures were above the known thresholds for thermal injury and necrosis. Subsequently, strategies designed to allow for safe ultrasonic cement removal from the humerus were applied, including intermittent delivery of energy and the use of cold irrigation between probe passes. These strategies resulted in markedly lower maximum temperatures in all tissues tested. CONCLUSIONS: Temperatures in the humerus, triceps, and, most importantly, the radial nerve can reach potentially dangerous levels when ultrasound technology is used to remove cement from the humerus. We suggest intermittent cold irrigation of the humeral canal, no tourniquet use, education of surgeons with regard to proper techniques designed to limit heat generation, and consideration of exposure and protection of the radial nerve when ultrasound devices are used.- - - - - - - - - - ranking = 1.4690535325618keywords = nerve (Clic here for more details about this article) |
10/45. Clinical holistic medicine: chronic infections and autoimmune diseases.The consciousness-based (holistic) medical toolbox might be useful in general practice and in cases of recurrent infections and chronic infection or inflammation. From our clinical experiences, there is hope for improvement from a number of diseases caused by disorders affecting the regulation of the immune system when the physician includes the holistic medical approach. Our scientific understanding of the connection between consciousness and cellular order is still limited. consciousness-based holistic medicine removes (as explained by the holistic process theory of healing) the "blockages" in the tissues of the body and facilitates function and informational exchange of the cells of the body. Many blockages and repressed feelings in an area would imply "noise and disturbances" on the level of intercellular communications, which in turn means major difficulties for the cells of the immune system. For this they are totally dependent on the body information system, which the holistic treatment aims to recover. Processing the blockages increases the coherence of the cells and organism, thus increasing the intercellular flow of information in the area and thus strengthening the immune defense and healing the disease. The area of clinical holistic medicine is going through a rapid development and the toolbox of consciousness-based medicine is available for dealing with many diseases arising from disturbances in the regulation of the immune system. Holistic medicine has yet to be better explained scientifically and our proposed holistic cures have yet to be documented clinically. We invite the medical community to cooperate on this important challenge.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
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